Investigators offered updated recommendations regarding the use of the trabecular bone score in the clinical management of patients with primary or secondary osteoporosis, according to a new position paper published by Shevroja et al in Osteoporosis International. After initially publishing a literature review on the trabecular bone score in 2015—which highlighted that the score may be effective in predicting hip and major osteoporotic fractures and was potentially amenable to change as a result of pharmacological therapy—the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, in partnership with the International Osteoporosis Foundation, revisited the literature to revise their earlier recommendations. Investigators analyzed data from 96 articles to determine whether the trabecular bone score could offer benefit in fracture prediction in male and female patients, fracture prediction in patients with secondary osteoporosis, treatment initiation and monitoring in postmenopausal patients with osteoporosis, and treatment monitoring in patients with secondary osteoporosis. They found that the score improved fracture risk prediction in patients with primary or secondary osteoporosis, helped inform treatment initiation and decision-making when utilized alongside assessments of bone mineral density and clinical risk factors, and provided useful adjunctive information for patients treated with long-term denosumab and anabolic agents. The investigators hope their new findings can encourage the greater integration of the trabecular bone score into the clinical management of patients with osteoporosis.