Increasing soft tissue thickness does not affect trabecular bone score reproducibility: a phantom study

Carmelo Messina, Alessandro Poloni, Vito Chianca, Domenico Albano, Luca Petruccio Piodi, Fabio Massimo Ulivieri, Luca Maria Sconfienza

Research output: Contribution to journalArticlepeer-review


Purpose: Trabecular Bone Score (TBS) provides an indirect score of trabecular microarchitecture from lumbar spine (LS) dual energy X-ray absorptiometry. Increasing soft tissue thickness artifactually reduces TBS values; we evaluated the effect of a fictitious increase of soft tissue thickness on TBS and bone mineral density (BMD) reproducibility on a phantom model. Methods: A Hologic spine phantom was scanned with a QDR-Discovery W Hologic densitometer. Fresh pork rind layers of 5 mm were used to simulate the in-vivo soft tissues. For each scan mode (fast array [FA], array, high definition [HD]), 25 scans were consecutively performed without phantom repositioning, at 0 (no layers), 1 cm, 3 cm, and 6 cm of thickness. BMD and TBS reproducibility was calculated as the complement to 100% of least significant change. Results: Both BMD and TBS reproducibility slightly decreased with increasing soft tissue; this difference was statistically significant only for BMD using HD modality (reproducibility decreased from 99.4% at baseline to 98.4% at 6-cm of thickness). TBS reproducibility was slightly lower compared to that of BMD, and ranged between 98.8% (array, 0 cm) and 97.4% (FA, 6 cm). Without taking into account manufacturer BMI optimization, we found a progressive decrease of TBS mean values with increasing soft tissue thickness. The highest TBS difference between baseline scan and 6 cm was −0.179 (−14.27%) using HD. Conclusions: Despite being slightly lower than that of BMD, TBS reproducibility was not affected up to 6 cm of increasing soft tissue thickness, and was even less influenced by fat than BMD reproducibility.

Original languageEnglish
Pages (from-to)336-342
Number of pages7
Issue number2
Publication statusPublished - 2018


  • Dual energy X-ray absorptiometry
  • Phantom
  • Precision
  • Reproducibility
  • Trabecular bone score

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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