Trabecular Bone Score in Individuals with Chronic Spinal Cord Injury: A Cross-Sectional Study

Objectives: To describe lumbar spine (LS) trabecular bone score (TBS) values after SCI, and to explore the differences in fractures risk assessment between FRAX (R) and TBS-adjusted FRAX (R) in individuals living with chronic SCI. Methods: Baseline dual-energy x-ray absorptiometry (DXA) scans from an established cohort were acquired using a Hologic Discovery QDR 4500. TBS measurements were performed using the TBS iNsightTM software version 2.1.2.0. A Welch's t-test was performed to explore differences in TBS, FRAX (R), and TBS-adjusted FRAX (R) between men and women, between participants <= 49 years and >= 50 years, and between subgroups with and without history of fracture and with complete and incomplete injury. Results: We analyzed 37 scans; the mean TBS was 1.336 +/- 0.107. The mean 10-year fracture risk was 8.8% +/- 11.4% for major osteoporotic fracture and 4.0% +/- 10.8% for hip fracture according to FRAX (R), and 6.6% +/- 2.8% for major osteoporotic fracture and 2.8% +/- 6.7% for hip fractures according to TBS-adjusted FRAX (R). The 10-year fracture risk for major osteoporotic fractures was higher in individuals with a prior fragility fracture compared to those without, according to FRAX (R)(p = .033) and TBS-adjusted FRAX (R) (p = .001). Conclusion: Over a half of our sample presented a partially degraded bone microarchitecture based on TBS. TBS was not different between people with motor complete and motor incomplete injury or with and without prior fragility fracture. Future studies are needed to define the clinical relevance of TBS and TBS-adjusted FRAX (R) in people with chronic SCI.