The TBS has recently been shown to predict fracture risk in different forms of osteoporosis, either as an adjunct to BMD (e.g. in patients with diabetes, patients receiving glucocorticoid therapy, or patients with endogenous Cushing’s syndrome) or independently (e.g. in post-menopausal women, hemodialysis patients, and breast cancer survivors receiving aromatase inhibitors) (22–25). This evidence concerns the gene CYP19A1 and Cushing syndrome due to macronodular adrenal hyperplasia.