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Published on: January 29, 2018
TBS (trabecular bone score) and diabetes-related fracture risk
William D Leslie1, Berengère Aubry-Rozier, Olivier Lamy
1Department of Medicine (C5121), St Boniface General Hospital, 409 Tache Avenue, Winnipeg, MB, Canada R2H 2A6. bleslie@sbgh.mb.ca
Context:
Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD.
Objective:
This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes.
Design And Setting:
We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada.
Patients:
We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes.
Main Outcome Measures:
Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years).
Results:
Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements.
Conclusions:
Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.
