Wow, I feel like I'm following you down the same rabbit hole! After being diagnosed recently with osteoporosis, among the many studies I've dug up are:

* Is bone mineral density predictive of fracture risk reduction?
<at nih gov site>
and
* Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of
bone density: The manitoba study
<at asbmr online library>

If I'm interpreting that latter study right, a TBS score is, or at least *can* be "derived" from a *prior* DXA scan. Search on the word "derived" and see what you come up with as far as interpreting this. Studies are so hard to interpret! I want at least a CliffNotes Version Conclusions section. 🙂 What this study concluded as far as the *helpfulness* of TBS scores, at least in this particular study, is even fuzzier to me than whether a TBS score can be figured *after the fact* (= after a DXA scan, then taken from the DXA scan figures/images).

I had also seen the article you're referencing, called "A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX" from a Journal of Bone and Mineral Research (JBMR) -- Vol. 31, No. 5, May 2016, pp 940–948a. I got it from Sara Meeks, a physical therapist who has many videos on YouTube and is quite an exercise/physical therapy expert. That study says: "When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture."