Li G, Leslie WD, Kovacs CS, et al. - In view of the suboptimal predictive power in fracture risk assessment tools, researchers here investigated the predictive accuracy of the combination of frailty and trabecular bone score (TBS) for risk of major osteoporotic fracture (MOF). The prospective longitudinal study of CaMos (Canadian Multicentre Osteoporosis Study) was used to obtain data for this study. Using lumbar spine (L1 - L4) DXA images, they estimated TBS values; a frailty index (FI) of deficit accumulation was determined for frailty evaluation. They analyzed 2,730 participants (mean age: 69 years; 70% women; mean follow-up: 7.5 years). During follow-up, 243 (8.90%) MOFs were observed. Relative to participants without MOF, those with MOF exhibited significantly higher FI (0.24 vs 0.20) and lower TBS (1.231 vs 1.285). The analysis thereby suggests a significant and independent correlation of frailty and TBS with MOF risk. As the model FI+TBS led to only minimal and non-significant enhancement of discrimination and net reclassification improvement despite being a better fit to the data than FI-alone and TBS-alone, they suggest performing larger studies to ascertain if combining frailty and TBS can generate improved predictive accuracy for MOF risk.