Paggiosi MA, et al. - Researchers assessed whether and to what extent a discrimination can be made between postmenopausal women with low areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry with and without vertebral fractures, based on the measurements of lumbar spine bone mineral apparent density (BMAD), trabecular bone score (TBS) and volumetric bone mineral density (vBMD). Three categories of postmenopausal women were analyzed: group 1, aBMD T-score < − 1.0 and ≥ 1 vertebral fracture (n = 39); group 2, aBMD T-score < − 1.0 and no vertebral fracture, age- and aBMD-matched to group 1 (n = 34); group 3, aBMD score > − 1 and no vertebral fracture, age-matched to group 1 (n = 37). They concluded that since lumbar spine vBMD affords a 3D measure of bone mineral density, excludes the posterior elements of the vertebrae and considers bone size, it may provide a good discrimination between postmenopausal women with low aBMD with and without vertebral fractures. The findings of this work are independent of aBMD because a unique feature of the SHATTER study is that groups 1 and 2 were matched for aBMD. The inability of BMAD and TBS to discriminate between women with low aBMD with and without vertebral fractures was also observed.