Background: Degenerative diseases associated with aging lumbar spondylosis, a higher lumbar spine BMD (bone mineral density) may be artifactually caused by osteophytes. TBS (trabecular bone score) is a textural metric that uses specialized software to assess pixel grey level changes in lumbar spine DEXA (dual-energy x-ray absorptiometry) images can used alternative measure the risk of fracture.The purpose of the research was to compare the TBS and BMD scores in patients with lumbar spondylosis and the contribution of TBS, BMD, measurements from DEXA to the prediction of fracture risk.Patients and Method: In this cross-sectional comparative research, 250 participants with and without sciatica had back discomfort. Every patient answered questions on osteoporosis risk factors and sociodemographic characteristics. A conventional radiography was used, with the film centred at the second lumbar vertebra. A lone observer then assessed the radiographs to determine if the patient had lumbar spondylosis using the Kellgren-Lawrence Score. The patients were split into two groups: those with spondylosis in group B and those without (group A). The GE-Lunar Prodigy Advance instrument and program (encore version 17) were used to measure the bone mineral density (BMD) of the lumbar spine (first to fourth lumbar vertebrae). Anteroposterior DEXA was reanalyzed as part of the TBS evaluation risk in patients with lumbar spondylosis. Results: Lower TBS (only 31.3% of grade 1 spondylosis cases had a TBS < 1.20, while 73.7% of grade 4 spondylosis cases had a TBS < 1.20 with a p value of 0.044) and increased BMD (50% of grade 1 spondylosis cases had a BMD <-2.5, compared to only 5.3% of grade 4 spondylosis cases had a BMD <-2.5 with a p value of 0.018) were found to be associated with lumbar spondylosis. Additionally, BMD is not significantly correlated with TBS in cases with spondylosis (TBS <1.20 with p value of 0.391 in 37.5% of cases with BMD >-1 and 44.4% of patients with BMD <-2.5 had TBS > 1.20). This is in contrast to findings in instances without spondylosis (54.0% of cases with BMD <-2.5 had TBS > 1.20 and, with a p-value of 0.001, 32.7% of cases with BMD >-1 had TBS <1.20. The correlation coefficients in groups A and B for BMD and FRAX were -0.820 and -0.708, respectively, indicating a weaker relationship between the two variables in the spondylosis cases compared to the non-spondylosis cases. However, there was no significant difference in the correlation coefficients for TBS and FRAX between the spondylosis and non-spondylosis cases (-0.373 and -0.436, respectively, with a p value of 0.486).Conclusion: The lumbar spine's TBS provides a more precise indicator of the likelihood of a fracture in cases of lumbar spondylosis. Lumbar spondylosis's radiographic characteristics raised BMD but had no effect on TBS values.

Keywords: DEXA, BMD, TBS, osteoporosis, lumber spondylosis