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Background: Ethnicity differentially modulate fracture risk prediction using FRAX™-bone mineral density (BMD). Objective: To compare FRAX™-BMD and trabecular bone score (TBS)-adjusted FRAX™ in the 10-year probability of fracture among Thai postmenopausal woman (PMW) with vertebral fracture (VF). Materials and Methods: The present study was a cross-sectional study conducted by retrospective review of medical records of PMW with VF older than 45 years undergoing lumbar and hip DXA scan. The authors excluded the PMW having been treated with metal implant at the spine, 3 or more lumbar VF, or cancer spreading to vertebral spine. The authors assessed the difference in means of normally distributed data by dependent sample t-test, the correlation between TBS and LS BMD by Pearson correlation, and the difference in proportions of PMW who met intervention threshold (IT) before and after TBS-adjusted FRAX™ by McNemar's test. A p<0.05 was considered statistically significant. Results: Of the 119 patients, the mean age was 70.8±8.1 years. The mean 10-year probability of a hip fracture by TBS-adjusted FRAX™ was significantly higher than that by FRAX™-BMD with the mean difference of 0.44% (95% CI 0.13 to 0.76). The higher difference in means, using TBSadjusted FRAX™, was even significantly greater in the 10-year probability of major osteoporotic fractures. For either the IT of major osteoporotic fracture or hip fracture, TBS-adjusted FRAX™ resulted in four added PMWs who needed treatment, but without statistical significance. Conclusion: TBS-adjusted FRAX™ had a higher 10-year probability of fracture than FRAX™-BMD. [ABSTRACT FROM AUTHOR]