Assessment of bone health is essential in many different diseases and conditions, including osteoporosis and fragility fracture. Although bone mineral density (BMD) has a well-established role in measuring the bone quantity, it is unable to determine bone quality. Recently trabecular bone score (TBS) has developed as a valuable approach toward determining bone quality via the evaluation of bone microarchitecture. TBS data is of critical importance, particularly in conditions that BMD is falsely elevated or has not yet decreased significantly. This review collects current evidence regarding the clinical applications of TBS in various disorders, such as osteoporosis, fracture, diabetes, chronic kidney disease, and degenerative bone diseases.