Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 6;20(1):110.
doi: 10.1007/s11657-025-01595-4.

Reference curves for trabecular bone score adjusted for soft tissue thickness in children and adolescents from Mexico City

Miguel Angel Guagnelli  1 , Desiree Lopez-Gonzalez  1 , Karen Hind  2   3   4 , Enisa Shevroja  5 , Didier Hans  5 , Patricia Clark  6
Affiliations

Reference curves for trabecular bone score adjusted for soft tissue thickness in children and adolescents from Mexico City

Miguel Angel Guagnelli et al. Arch Osteoporos. .

Abstract

This study proposes age- and sex-specific trabecular bone score (TBS) reference curves for Mexican children and adolescents. Using the latest software version, results highlight significant pubertal changes and provide reference data for assessing pediatric bone health, paving the way for a wider use of this technology in children and adolescents.

Purpose: Trabecular Bone Score (TBS) is a grey scale texture measure that correlates with bone microarchitecture derived from dual-energy X-ray absorptiometry (DXA). While extensively studied in adults, limited data exist for pediatric populations. This study aims to develop age- and sex-specific reference curves for TBS adjusted for abdominal soft tissue thickness in healthy children and adolescents from Mexico City.

Methods: This cross-sectional study reanalyzed data from 1552 healthy participants (5-18 years) who underwent lumbar spine DXA scans using Lunar iDXA and TBS iNsight 4.0 (Core Module 19.4.0), which accounts for soft tissue thickness. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were employed to construct smoothed percentile curves. TBS values were stratified by age, sex, and Tanner stage, with descriptive statistics and outlier exclusions.

Results: TBS showed distinct age- and sex-related trajectories, with steep increases during puberty. Girls demonstrated a sharper rise in TBS starting at age 9, peaking by age 16, while boys exhibited a more gradual increase starting at age 10-11, peaking by age 18. Differences were also observed between Tanner stages, with the most significant changes occurring from stages 2 to 3.

Conclusion: This study proposes the first TBS reference curves for Mexican children and adolescents using the latest software version. This data may prove to be a valuable tool for assessing bone health in pediatric populations. Yet further research to explore TBS's utility in predicting bone fragility in pediatric population as well as its life-course trends.

Keywords: Pediatrics; Puberty; Reference curves; Trabecular bone score (TBS).

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflicts of interest: Didier Hans is co-owner of the TBS patent and has corresponding ownership shares and position at medimaps group.

Figures

Fig. 1
Fig. 1
Flowchart of participants
Fig. 2
Fig. 2
Age-related percentile curves for mean trabecular bone score (TBS) version 4.0 (core module version 19.4.0) in boys aged 5 to 18 years. Percentiles are displayed in legend. Lines represent smoothed percentiles fitted using the GAMLSS model
Fig. 3
Fig. 3
Boxplot representing TBS distributions by Tanner stage for males and females. In both sexes, TBS values increase progressively with pubertal development, with a marked rise from Tanner stages 2 to 4. The trend is more pronounced in females, consistent with earlier pubertal timing. Sample sizes for each stage are shown alongside the boxplots
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Palomo T, Muszkat P, Weiler FG, Dreyer P, Brandao CMA, Silva BC (2022) Update on trabecular bone score. Arch Endocrinol Metab 66(5):694–706 - PMC - PubMed
    1. Shawwa K, Arabi A, Nabulsi M, Maalouf J, Salamoun M, Choucair M et al (2015) Predictors of trabecular bone score in school children. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA - PubMed
    1. Dowthwaite JN, Winzenrieth R, Binkley N, Krueger D, Scerpella TA (2017) A focused evaluation of lumbar spine trabecular bone score in the first year post-menarche. Arch Osteoporos 12(1):90 - PubMed
    1. Kalkwarf HJ, Shepherd JA, Hans D, Gonzalez Rodriguez E, Kindler JM, Lappe JM et al (2022) Trabecular bone score reference values for children and adolescents according to age, sex, and ancestry. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 37(4):776–785 - PMC - PubMed
    1. Fraga MM, de Sousa FP, Szejnfeld VL, de Moura Castro CH, de Medeiros PM, Terreri MT (2023) Trabecular bone score (TBS) and bone mineral density (BMD) analysis by dual X-ray absorptiometry (DXA) in healthy Brazilian children and adolescents: normative data. Arch Osteoporos 18(1):82 - PubMed

LinkOut - more resources