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Bone quality assessment in type 2 diabetes mellitus
R Dhaliwal1, D Cibula, C Ghosh
1Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA, dhaliwar@upstate.edu.
Summary
Type 2 diabetes mellitus (T2DM) is linked to poorer bone quality, as indicated by a lower trabecular bone score (TBS). This reduced bone quality, particularly in T2DM patients with poor glycemic control, may explain increased fracture risks.
Area of Science:
- Endocrinology
- Orthopedics
- Bone Metabolism
Background:
- Type 2 diabetes mellitus (T2DM) is associated with an elevated risk of osteoporotic fractures, despite patients often exhibiting higher average bone mineral density (BMD).
- The underlying mechanisms for this paradox, where increased fracture risk coexists with higher BMD in T2DM, remain incompletely understood.
- Trabecular bone microarchitecture, a key determinant of bone strength, is increasingly recognized as crucial for fracture prediction.
Purpose of the Study:
- To assess trabecular bone quality in women with T2DM using the trabecular bone score (TBS).
- To compare TBS and BMD in women with and without T2DM.
- To investigate the association between glycemic control and trabecular bone quality in T2DM.
Main Methods:
- A cross-sectional study involving 57 women with T2DM and 43 women without diabetes (ages 30-90).
- Lumbar spine bone mineral density (BMD) measured via dual-emission x-ray absorptiometry (DXA).
- Trabecular bone score (TBS) calculated from DXA images using TBS iNsight software to analyze pixel variations, assessing trabecular microarchitecture.
Main Results:
- Mean TBS was significantly lower in women with T2DM (1.228 ± 0.140) compared to controls (1.298 ± 0.132, p=0.013).
- Mean BMD was higher in the T2DM group (1.150 ± 0.172) versus controls (1.051 ± 0.125, p=0.001).
- Within the T2DM cohort, lower TBS was associated with poorer glycemic control (HbA1c > 7.5%).
Conclusions:
- Trabecular bone score (TBS) is reduced in individuals with type 2 diabetes mellitus (T2DM).
- A lower TBS in T2DM is significantly associated with poorer glycemic control.
- Abnormal trabecular microarchitecture, as assessed by TBS, may elucidate the increased fracture risk observed in T2DM despite higher BMD.
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