Pediatric Trabecular Bone Score Reference Ranges Assessed

pediatric bones
pediatric bones
Investigators assessed age, sex, and population ancestry effects on trabecular bone score to develop reference ranges for children and adolescents.

A team of investigators defined age, gender, and population ancestry (African vs non-African) references for trabecular bone score ranges for children and reported their findings in the Journal of Bone Mineral Research.

Data for this study were sourced from the Bone Mineral Density in Childhood Study, which was a longitudinal study conducted at 5 centers in the United States between 2002 and 2009. Children and adolescents (N=2014) aged 5 to 19 years were evaluated for anatomical characteristics and underwent assessment via dual-energy x-ray absorptiometry.

The study participants were grouped into non-Black boys (n=745), Black boys (n=246), non-Black girls (n=789), and Black girls (n=232) cohorts.

Trabecular bone scores were consistent at younger ages and increased rapidly during pubertal growth. Age-related increases in TBS occurred earlier for girls than boys, corresponding with earlier puberty growth.

Trabecular bone score was best fit by a fourth-degree polynomial for age (P =.0024). Age-related trajectories differed for gender (P =.0008) but not population ancestry for either boys (P =.48) or girls (P =.43).

Trabecular bone score Z-scores were correlated with height for boys (r, 0.15; P <.0001) and girls (r, 0.20; P <.0001) and body mass index (BMI) Z-scores for boys (r, 0.09; P <.0001) and girls (r, 0.18; P <.0001). Stratified by age, the association between trabecular bone score Z-scores and height or BMI Z-scores was not significant at younger ages.

Trabecular bone score Z-scores at baseline correlated with those after 6 years (r, 0.47; P <.0001); the correlation was stronger for individuals aged 15 years and older at baseline (r, 0.69) than for those younger than 10 years (r, 0.40) or those aged 10 to 14.9 years (r, 0.48).

Trabecular bone score explained between 17% and 27% of the variance in bone density measures. Stratified by trabecular bone score Z-scores, 20.5% of individuals with low trabecular bone scores had low lumbar spine areal bone mineral density (aBMD), 14.4% had low height-for-age Z-scores-adjusted aBMD, and 13.5% had low bone mineral apparent density (BMAD) Z-scores.

This study may have been limited by excluding children with low or high BMI. It remains unclear whether these findings may be generalizable to underweight or overweight children.

The study authors concluded, “In sum, we provide robust reference ranges for [trabecular bone score] in a well-characterized pediatric cohort. We found that [trabecular bone score] Z-scores provided information distinct from spine aBMD and BMAD Z-scores. These [trabecular bone score] reference ranges provide the foundation for future studies that evaluate the determinants of bone health and utility of [trabecular bone score] as a predictor of bone fragility in childhood and adolescence.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Kalkwarf HJ Shepherd JA, Hans D, et al. Trabecular bone score reference values for children and adolescents according to age, sex, and ancestry. J Bone Miner Res. Published online February 3, 2022. doi:10.1002/jbmr.4520