Complementary effects of trabecular bone score and hip axis length on fracture risk: the Manitoba bone mineral density (BMD) Registry
Authors' conclusion
TBS and HAL showed mutually independent and complementary benefits for fracture prediction.
Study context
- Population
- Individuals aged ≥ 40 years from the Manitoba Bone Density Program with baseline trabecular bone score (TBS) and hip axis length (HAL) measurements (mean age 63.5 years, 90.9% female)
- Participants
- 55,068 individuals
- Exposure
- TBS vs HAL, separately and in combination, for fracture risk
- Outcome
- Incident MOF and hip fractures
Methodological detailsregistry-based, population-based linked healthcare data, Cox regression, multivariable-adjusted
- Registry-based
- Population-based linked healthcare data
- Cox regression, multivariable-adjusted
Main finding
As reported in the abstract
Incident MOF, fully adjusted model with total hip BMD, TBS and HAL evaluated simultaneously
TBS (per SD decrease): 16% increase in major osteoporotic fractures (MOF) risk, HR 95% CI
1.12-1.19
HAL (per SD increase): 8% increase in MOF risk, HR 95% CI
1.05-1.11
Observational data: associations, not effects.
Further findings
Incident hip fracture, TBS and HAL evaluated simultaneously, adjusted for BMD
- HAL (per SD increase): 24% increased risk of hip fracture, HR 95% CI
- 1.18-1.30
- TBS (per SD decrease): 13% increased risk of hip fracture, HR 95% CI
- 1.07-1.19
TBS and HAL evaluated separately vs in combination
- Minimal differences
Original publication
Complementary effects of trabecular bone score and hip axis length on fracture risk: the Manitoba BMD Registry. Osteoporos Int. Published 18 November 2025. doi:10.
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