AimThe trabecular bone score (TBS) is a tool for assessing bone quality and health. Current TBS algorithm corrects for body mass index (BMI), as a proxy of regional tissue thickness. However, this approach fails to consider BMI inaccuracies due to individual differences in body stature, composition and somatotype. This study investigated the relationship between TBS and body size and composition in subjects with a normal BMI, but with large morphological diversity in body fatness and height.MethodsYoung male subjects (n = 97; age 17.2±1.0 years), including ski jumpers (n = 25), volleyball players (n = 48) and non-athletes (controls n = 39), were recruited. The TBS was determined from L1-L4 dual-energy X-ray absorptiometry (DXA) scans using TBSiNsight software.ResultsTBS correlated negatively with height and tissue thickness in the L1-L4 area in ski jumpers (r = -0.516 and r = -0.529), volleyball players (r = -0.525 and r = -0.436), and the total group (r = -0.559 and r = -0.463), respectively. Multiple regression analyses revealed that height, L1-L4 soft tissue thickness, fat mass and muscle mass were significant determinants of TBS (R2= 0.587, p<0.001). L1-L4 soft tissue thickness explained 27% and height 14% of the TBS variance.ConclusionThe negative association of TBS and both features suggests that a very low L1-L4 tissue thickness may lead to overestimation of the TBS, while tall stature may have the opposite effect. It seems that the utility of the TBS as a skeletal assessment tool in lean and/or tall young male subjects could be improved if tissues thickness in the lumbar spine area and stature instead of BMI were considered in the algorithm.