Category: Central DXA: (DXA, TBS)

33 - Professional Athletes with Fractures May Have a “Degraded” Trabecular Bone Score (TBS)

Background: Since the 2000 NIH Consensus Conference, the relationship that Bone Strength = Bone Quality + Bone Density has been utilized in understanding skeletal resistance to fracture.
Many elite athletes suffer fractures, predominantly acute traumatic or stress; many suffer recurrences.

Stress fractures, classically, have been divided into fatigue and insufficiency fractures. At least part of the pathogenesis of stress injuries has been hypothesized to be due to micro-damage accumulation.
We have used DXA, in the past, to assist in making the decision between fatigue and insufficiency fractures. But, micro-damage and other Bone Quality characteristics, possible components of stress reactions and fractures, are not assessable by DXA.

TBS is a textural analysis of the pixels of the LS spine DXA providing an indirect measure of trabecular architecture and it has been proposed as a measure of Bone Quality. TBS software was approved by the FDA in October, 2013. NCIBH has utilized this software since November, 2013. The purpose of this study was to evaluate the role of TBS in the assessment of Bone Quality in fracturing elite athletes.
Since then, we evaluated more than 20 athletes prospectively and found several with “degraded” or “partially degraded” TBS. Therefore, in February, 2016, we retrospectively reviewed the TBS in all elite athletes who had DXA studies at our facility since 2006 and had been seen prior to November, 2013.
We studied 10 MLB and 5 Minor LB players; 8 NBA and 2 college basketball players; 5 active NFL players and 1 retired NFL player; and, 4 amenorrheic runners utilizing gender and ethnicity specific databases.
One MLB player (Black ethnicity) and one Minor League (White) had “degraded” TBS; one Minor League player (White) had “partially degraded” TBS; 2 NBA players (Black) had “degraded” TBS and one had “partially degraded” TBS (White); and one NFL player (Black) had “partially degraded” TBS. These individuals all had high BMD and, thus, their BMD and TBS were discordant.

This is not a randomized sample of any elite athletic population but, rather, a select referral population. Yet, whatever “abnormal” TBS represents, it is clearly present in some of these athletes with bone health issues.
Although the prevalence of “degraded” and “partially degraded” TBS in fracturing elite athletes is not known, this exploratory analysis suggests TBS needs to be further studied in this population to clarify the role of reduced Bone Quality in their fractures.

Christelle Domantay, XT

DXA Densitometrist
Northern California Institute of Bone Health, Inc.
Orinda, California

Elliott N. Schwartz

Institute Director
Northern California Institute for Bone Health, Inc.
Orinda, California

Patricia Schwartz, RN, XT

Registered Nurse and Office Manager
Northern California Institute of Bone Health, Inc.
Orinda, California

Clinten P. Edmondson, B.S.

Information Technology Manager
Northern California Institute of Bone Health, Inc.
Orinda, California