Trabecular Bone Score (TBS)

I will be asking that a Trabecular Bone Score (TBS) be included with my next DXA scan. The doctor who read my latest scan wrote, "Follow up with DEXA and TBS: As needed." 

I found a review of TBS. The review includes a section on "Changes in TBS with Treatment of Osteoporosis." Below is the paragraph comparing the effects of strontium ranelate and alendronate (Fosamax) on TBS. 

"The effects of strontium ranelate (SrRan) and alendronate on TBS were evaluated in a post hoc analysis performed in 79 women with postmenopausal osteoporosis of 189 included in a double‐blind, double‐dummy, randomized study. Women were randomized to either SrRan 2 g/day or alendronate 70 mg/week for 2 years. TBS and BMD parameters were assessed in the LS after 12 and 24 months of treatment. Over 1 and 2 years, LS BMD increased significantly by 5.6% and 9.0% in the SrRan group and by 5.2% and 7.6%, respectively, in the alendronate group. LS TBS increased by 2.3% (p < 0.001) and 3.1% (p < 0.001) in the SrRan group, but the change in the alendronate group was not significant (0.5% and 1.0%, respectively). There was a significant between‐group difference with SrRan showing larger TBS increases than alendronate."

Let me reiterate: Over one and two years, Lumbar Spine (LS) BMD increased in both the SrRan (5.6%, 9.0%) and alendronate groups (5.2%, 7.6%). You will note that the SrRan BMD numbers are higher, especially after the second year, than the alendronate numbers. The results are as expected because strontium results in an overestimation of BMD.  

HERE IS THE KICKER: LS TBS increased by 2.3% and 3.1% in the SrRan group, but the change in the alendronate group was not significant (0.5% and 1.0%, respectively). There was a significant between‐group difference with SrRan showing larger TBS increases than alendronate.

Keep in mind that TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard BMD measurement. TBS may be a better predictor of fracture risk than BMD alone. 
https://www.panoramaortho.com/wp-content/uploads/2019/03/TBS-Rev...

 

DXA Scan of 18 August 2022 Showing Normal Density

Below is my recent axial DXA performed on a Horizon Prologic Wi DXA scanner and showing NORMAL BONE DENSITY! Even if my scores are lower by half due to strontium use, the changes are phenomenal. Fifteen years ago, I was diagnosed with osteoporosis. My scans have gotten progressively better since I began taking strontium citrate 14 years ago. For my next DXA scan, I will ask that a Trebecular Bone Score (TBS) be included.Trabecular bone score (TBS) uses standard lumbar spine DXA imaging to assess bone texture inhomogeneity (that is, the number of filled versus unfilled voxels) in order to gauge bone quality and fracture risk. Strontium will not affect TBS as it does DXA. 

EXAM:  DXA AXIAL 8/18/2022

 INDICATION:  Postmenopausal.

 COMPARISON: 1/8/2018

 

FINDINGS:

 

Spine:  Total BMD of the spine L1-4 is 1.030 g/cm2, with a T-score of -0.2 and a Z-score of 2.2.

Left Femoral Neck: BMD is 0.741 g/cm2, with a T-score of -1.0  and a Z-score of 1.1.

 

Left Total Hip: BMD is 0.856 g/cm2, with a T-score of -0.7 and a Z-score of 1.0.

 

Right Femoral Neck: BMD is 0.752 g/cm2, with a T-score of -0.9 and a Z-score of 1.2.

Right Total Hip: BMD is 0.907 g/cm2, with a T-score of -0.3 and a Z-score of 1.5.

Spine density increased 5.2%. Left hip density decreased 1%. Right hip density increased 0.9%. These percent change findings may be inaccurate as exam was performed with different technique.

FRAX evaluation calculates 10-year probability of fracture:

 Major Osteoporotic: 7.9%%

 Hip: 1.3%%

IMPRESSION:

 Based on BMD, diagnosis is consistent with normal density.

 Follow up with DEXA and TBS: As needed.

WHO CRITERIA FOR T-SCORES:

 < or = -2.5 = osteoporosis

 < -1.0 and -2.5 = osteopenia

 > or = -1.0 = normal density

Calcium Intake and BMD

The following report is a systematic review and meta-analysis (the highest level of scientific proof) on calcium intake and bone mineral density. 

Abstract

Objective To determine whether increasing calcium intake from dietary sources affects bone mineral density (BMD) and, if so, whether the effects are similar to those of calcium supplements.

Design Random effects meta-analysis of randomised controlled trials.

Data sources Ovid Medline, Embase, Pubmed, and references from relevant systematic reviews. Initial searches were undertaken in July 2013 and updated in September 2014.

Eligibility criteria for selecting studies Randomised controlled trials of dietary sources of calcium or calcium supplements (with or without vitamin D) in participants aged over 50 with BMD at the lumbar spine, total hip, femoral neck, total body, or forearm as an outcome.

Results We identified 59 eligible randomised controlled trials: 15 studied dietary sources of calcium (n=1533) and 51 studied calcium supplements (n=12 257). Increasing calcium intake from dietary sources increased BMD by 0.6-1.0% at the total hip and total body at one year and by 0.7-1.8% at these sites and the lumbar spine and femoral neck at two years. There was no effect on BMD in the forearm. Calcium supplements increased BMD by 0.7-1.8% at all five skeletal sites at one, two, and over two and a half years, but the size of the increase in BMD at later time points was similar to the increase at one year. Increases in BMD were similar in trials of dietary sources of calcium and calcium supplements (except at the forearm), in trials of calcium monotherapy versus co-administered calcium and vitamin D, in trials with calcium doses of ≥1000 versus <1000 mg/day and ≤500 versus >500 mg/day, and in trials where the baseline dietary calcium intake was <800 versus ≥800 mg/day.

Conclusions Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture.

Conclusions

In summary, increasing calcium intake from dietary sources increases BMD by a similar amount to increases in BMD from calcium supplements. In each case, the increases are small (1-2%) and non-progressive, with little further effect on BMD after a year. Subgroup analyses do not suggest greater benefits of increasing calcium intake on BMD in any subpopulation based on clinically relevant baseline characteristics. The small effects on BMD are unlikely to translate into clinically meaningful reductions in fractures. Therefore, for most individuals concerned about their bone density, increasing calcium intake is unlikely to be beneficial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784773/

My Current Supplements

My bone protocol consists of the following supplements. The dosage for each is  one capsule or tablet per day unless otherwise stated. 

AOR Strontium Support II, 341 mg strontium (from citrate) per capsule (two capsules daily)

Country Life, Gluten Free, Calcium Magnesium with Vitamin D Complex (250 mg Ca, 125 mg Mg, 100 I.U. Vitamin D per capsule) (two capsules daily)

Innate Vitality Magnesium Glycinate, 500 mg/capsule 

Nature Made Multi Men's 50+, No Iron (OK for men and women; contains 1000 IU vitamin D3 and 21 other nutrients) 

Nature Made D3, 1000 IU (one capsule three times/week)

I also take the following supplements for general health. The dosage for each is one capsule or tablet per day unless otherwise stated.

Solgar Citrus Bioflavonoid Complex, 1000 mg per tablet (Bioflavonoids are antioxidants.)

Solary Selenium, 100 mcg

Vitacost Chelated Zinc (zinc glycinate chelate), 30 mg

Doctor’s Best Lutein with Optilut (20 mg lutein, 4 mg zeaxanthin in two capsules)(2 capsules/day)

Nature Made Vitamin C, 500 mg

Solgar Natural Vitamin E (as d-Alpha Tocopherol plus d-Beta, d-Delta and d-Gamma Tocopherols), 400 IU

Horbaach Sublingual Methylcobalamin (Vitamin B12), 5000 mcg

I also take a couple of digestive aids: 

A probiotic (I am trying different brands.)

A multi-enzyme digestive (I am trying different brands.)