1. < Osteoporosis & Bone Health

Should I pursue a TBS score?

Posted by katwhisperer @katwhisperer, Dec 3, 2022

Hi all: my first post, although been lurking a while. What a terrific forum and kind group of people! I've read a few articles touting the growing value of TBS as a complementary tool to DXA, given its ability to measure bone strength. Wondering if anyone here had it done and if it yielded insightful results?

My first baseline DXA this past spring yielded -3.0 (back). Tymlos was recommended since I have major dental issues. I am 55, extremely fit with 35+ years of daily weight training and fairly high protein/clean eating - but am small framed. Could my bones be low density but stronger than avg thru decades of weight bearing exercise? Perhaps if my bones WERE stronger, even though less dense, I could maybe stall starting on these pharma solutions for a year or two?

I asked my PCP: he never heard of TBS. My rheumotologist dismissed it: didn't feel it would change his recommendations. Neither seems to want to write an RX for another DXA.

The facility for my 1st DXA can't do TBS or I'd just have them add it. No one will add a TBS score to an existing DXA unless it was done at their facility- and I need an RX to get a new DXA.

I was slated to start Tymlos this month. Do you think it's better to pause, find a new doc willing to write a DXA RX and see what the TBS reveals, before committing to a lifetime regimen of drug therapy (I have no clue what I'll be able to take after Tymlos, given my dental problems, which worries me.)

Any opinions most welcome! 🙂

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

JK | @contentandwell | Dec 4, 2022

Hi, @katwhisperer When I had my last DXA my endocrinologist did mention an additional test I could have and I believe that was the TBS. Unfortunately I didn't decide until it was too late to add that to the DXA. She did not push it, I think because she was not sure it would be covered by insurance, but I regret not getting it.
Keep in mind, that doctors want you to have DXAs at the same facility on the same machine each time you get them. I guess the machines are quirky and there can be differences in the results. If you think at some point you might want a TBS I would choose a facility for your DXA that can do that test.
JK

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1 reply
sheilad1 | @sheilad1 | Dec 4, 2022

I'm scheduled for a TBS test. I'm hoping it will be good enough so I Dont need meds. I Dont know exactly what it will mean.

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1 reply
nhorn | @nhorn | Dec 4, 2022
In reply to @sheilad1 "I'm scheduled for a TBS test. I'm hoping it will be good enough so I Dont..." + (show)
@sheilad1

I'm scheduled for a TBS test. I'm hoping it will be good enough so I Dont need meds. I Dont know exactly what it will mean.

Jump to this post

What is a TBS test?

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1 reply
katwhisperer | @katwhisperer | Dec 4, 2022
In reply to @nhorn "What is a TBS test?" + (show)
@nhorn

What is a TBS test?

Jump to this post

From my understanding, it's not really a "test" itself: it's an additionl score/measurement they can add TO the DXA imaging test. (If the facility's technology has this software capability - few do.)

I had to search far and wide for a place with TBS scoring capability. It measure strength of the bone where the traditional DXA measures density/thickness of bone. So potentially someone could have thinner bones, but strong. Or at least, that's my hope!

I don't mind starting on Tymlos, but the followup maintenance drugs are going to be a real problem for me.

REPLY
sheilad1 | @sheilad1 | Dec 5, 2022
In reply to @contentandwell "Hi, @katwhisperer When I had my last DXA my endocrinologist did mention an additional test I..." + (show)
@contentandwell

Hi, @katwhisperer When I had my last DXA my endocrinologist did mention an additional test I could have and I believe that was the TBS. Unfortunately I didn't decide until it was too late to add that to the DXA. She did not push it, I think because she was not sure it would be covered by insurance, but I regret not getting it.
Keep in mind, that doctors want you to have DXAs at the same facility on the same machine each time you get them. I guess the machines are quirky and there can be differences in the results. If you think at some point you might want a TBS I would choose a facility for your DXA that can do that test.
JK

Jump to this post

My doctor wanted a different facility because my numbers are so close to the margin of error. I could only find 2 facilities in South Florida that has a TBS machine. I'll post my results and if they affect anything once I get the score.

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inthemoment | @inthemoment | Dec 6, 2022

Hi all:

Has anyone had results that have included both a DXA and TBS score, where the TBS actually affected the recommended treatment? In other words, would your doctor have recommended the same course of treatment based on the DXA alone? (I understand the TBS score measures the strength of the bone. ) Does the TBS score provide additional information for treatment or is it primarily for diagnostic purposes?

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2 replies
Teri | @tsc | Dec 6, 2022
In reply to @inthemoment "Hi all: Has anyone had results that have included both a DXA and TBS score, where..." + (show)
@inthemoment

Hi all:

Has anyone had results that have included both a DXA and TBS score, where the TBS actually affected the recommended treatment? In other words, would your doctor have recommended the same course of treatment based on the DXA alone? (I understand the TBS score measures the strength of the bone. ) Does the TBS score provide additional information for treatment or is it primarily for diagnostic purposes?

Jump to this post

Hi @inthemoment, I can't answer your question, but I can share a little of what I understand about TBS, from hearing experts like Sara Meeks and Dr. Loren Fishman talk about it. TBS it measures the quality of bone vs quantity (as measured by the DXA scan) and is an indicator of bone health. There was a paper published in the Journal of Bone and Mineral Research, Vol 31, No. 5 May 2016, pp 940-948, "A Meta-Analysis of Traebecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX." It is highly technical, makes this point, "The question arises how many patients would be reclassified from low risk to high risk and vice versa with the consideration of TBS alongside FRAX or other risk instruments." It concludes"TBS is a consistent and significant predictor of fracture risk and provides information independently of FRAX...The findings of the study support the use of TBS as a standalone assessment of fracture risk, and using adjustnents from the Manitoba cohort, as a post hoc adjunct to risk assessment with FRAX."

I would jump at the chance to f get a TBS for a more complete picture of my bone health, but unfortunately, it's not available where I live. I hope this helps you.

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1 reply
inthemoment | @inthemoment | Dec 6, 2022
In reply to @tsc "Hi @inthemoment, I can't answer your question, but I can share a little of what I..." + (show)
@tsc

Hi @inthemoment, I can't answer your question, but I can share a little of what I understand about TBS, from hearing experts like Sara Meeks and Dr. Loren Fishman talk about it. TBS it measures the quality of bone vs quantity (as measured by the DXA scan) and is an indicator of bone health. There was a paper published in the Journal of Bone and Mineral Research, Vol 31, No. 5 May 2016, pp 940-948, "A Meta-Analysis of Traebecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX." It is highly technical, makes this point, "The question arises how many patients would be reclassified from low risk to high risk and vice versa with the consideration of TBS alongside FRAX or other risk instruments." It concludes"TBS is a consistent and significant predictor of fracture risk and provides information independently of FRAX...The findings of the study support the use of TBS as a standalone assessment of fracture risk, and using adjustnents from the Manitoba cohort, as a post hoc adjunct to risk assessment with FRAX."

I would jump at the chance to f get a TBS for a more complete picture of my bone health, but unfortunately, it's not available where I live. I hope this helps you.

Jump to this post

Thank you so much for this information. There will be a TBS machine available near me in the near future. I'm so glad I reached out to this forum.

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