Associations of Lean Mass, Muscular Strength, and Physical Function with Trabecular Bone Score in Older Adults

Margaret P. Seaton, Jeanne F. Nichols, Mitchell J. Rauh, Deborah M. Kado, Julie Loebach Wetherell, Eric J. Lenze, David Wing

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Introduction/Background: Trabecular bone score (TBS) is an indirect measurement of bone quality and microarchitecture determined from dual-energy X-ray absorptiometry (DXA) imaging of the lumbar spine. TBS predicts fracture risk independent of bone mass/density, suggesting this assessment of bone quality adds value to the understanding of patients’ bone health. While lean mass and muscular strength have been associated with higher bone density and lower fracture risk among older adults, the literature is limited regarding the relationship of lean mass and strength with TBS. The purpose of this study was to determine associations of DXA-determined total body and trunk lean mass, maximal muscular strength, and gait speed as a measure of physical function, with TBS in 141 older adults (65-84 yr, 72.5 +/- 5.1 yr, 74% women). Methodology: Assessments included lumbar spine (L1-L4) bone density and total body and trunk lean mass by DXA, lower body (leg press) and upper body (seated row) strength by one repetition maximum tests, hand grip strength, and usual gait speed. TBS was derived from the lumbar spine DXA scan. Multivariable linear regression determined the contribution of proposed predictors to TBS. Results: After adjusting for age, sex, and lumbar spine bone density, upper body strength significantly predicted TBS (unadjusted/adjusted R2= 0.16/ 0.11, β coefficient =0.378, p=0.005), while total body lean mass index showed a trend in the expected direction (β coefficient =0.243, p=0.053). Gait speed and grip strength were not associated with TBS (p>0.05). Conclusion: Maximum strength of primarily back muscles measured as the seated row appears important to bone quality as measured by TBS, independent of bone density. Additional research on exercise training targeting back strength is needed to determine its clinical utility in preventing vertebral fractures among older adults.

Original languageEnglish
Article number101370
JournalJournal of Clinical Densitometry
Issue number3
StatePublished - Jul 1 2023


  • Frailty
  • Lean tissue mass
  • Muscular strength
  • Osteosarcopenia
  • Trabecular bone score (TBS)


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