Trabecular Bone Score and Mortality Risk in a Population-Based Cohort of Older Adults

Background: Osteoporosis is consistently reported to increase mortality risk in older adults. Whether trabecular bone score (TBS), an indirect index of trabecular microarchitecture, increases mortality risk has not been widely studied.Methods: Participants aged 60 years and older in the National Health and Nutritional Examination Survey 2005 to 2008 with complete data on TBS lumbar vertebrae were linked to the public-use mortality files through December 31st, 2019. The X-tile software (version 3.6.1; Yale University) was used to obtain the overall and sex-specific optimal TBS cut-off values associated with all-cause mortality (log-rank test P<0.0001). Then, TBS was grouped into low (≤1.24), medium (1.25-1.39), and high (≥1.40) categories.Results: A total of 2,641 participants with a mean age of 69.8 (standard error 0.2) years comprised the study sample. Of those, 1,109 older adults died after a median follow-up of 140 months. Overall, survival probability progressively decreased across TBS categories, which was accentuated in subjects with low TBS. Cox regression analysis demonstrated that participants with low TBS had 47% (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.10-1.96) greater all-cause mortality risk than their counterparts with high TBS, even after accounting for potential confounders including bone mineral density. Notably, older adults with low TBS had 2-fold higher risk of cancer-related mortality than those with high TBS (HR, 2.07; 95% CI, 1.17-3.67).Conclusions: Low TBS was significantly associated with greater all-cause and cancer-related mortality in older adults.