In addition, clinical risk factors for fracture are at best an indirect assessment of the bone quality.
[citation needed] The trabecular bone score is a textural parameter that can be applied to DEXA, which quantifies the local variations in gray level.
[citation needed] It was found that TBS is a reflection of the structural condition of the bone microarchitecture.
Conversely, a low TBS value means that the microarchitecture of bone is incomplete and poorly connected with wide spaces between trabeculae.
[9] As TBS relies on measurement of soft tissue, it is considered unreliable in individuals with a BMI over 37,[10] or with extremely high waist circumference.