We propose to assess the associations of Trabecular Bone Score (TBS), a surrogate measure of bone trabecular microarchitecture, with incident major osteoporotic, hip, and radiographic vertebral fractures in men who participated in the Osteoporotic Fractures in Men (MrOS) study. We will determine whether or not prediction models of incident fractures that include TBS as a predictor are superior to those models that do not include TBS, and estimate associations of predictors with changes of TBS over time. Establishing the clinical utility of TBS in fracture risk assessment in men will lay the foundation for application in clinical practice to improve fracture prediction and reduce the societal burden of osteoporotic fractures in men.