Bone quality assessment in type 2 diabetes mellitus (original) (raw)

Abstract

Summary

The increased risk for fractures in type 2 diabetes mellitus (T2DM) despite higher average bone density is unexplained. This study assessed trabecular bone quality in T2DM using the trabecular bone score (TBS). The salient findings are that TBS is decreased in T2DM and low TBS associates with worse glycemic control.

Introduction

Type 2 diabetes mellitus is a risk factor for osteoporotic fractures despite high average bone mineral density (BMD). The aim of this study was to compare BMD with a noninvasive assessment of trabecular microarchitecture, TBS, in women with T2DM.

Methods

In a cross-sectional study, trabecular microarchitecture was examined in 57 women with T2DM and 43 women without diabetes, ages 30 to 90 years. Lumbar spine BMD was measured by dual-emission x-ray absorptiometry (DXA), and TBS was calculated by examining pixel variations within the DXA images utilizing TBS iNsight software.

Results

Mean TBS was lower in T2DM (1.228 ± 0.140 vs. 1.298 ± 0.132, p = 0.013), irrespective of age. Mean BMD was higher in T2DM (1.150 ± 0.172 vs. 1.051 ± 0.125, p = 0.001). Within the T2DM group, TBS was higher (1.254 ± 0.148) in subjects with good glycemic control (A1c ≤ 7.5 %) compared to those (1.166 ± 0.094; p = 0.01) with poor glycemic control (A1c > 7.5 %).

Conclusion

In T2DM, TBS is lower and associated with poor glycemic control. Abnormal trabecular microarchitecture may help explain the paradox of increased fractures at a higher BMD in T2DM. Further studies are needed to better understand the relationship between glycemic control and trabecular bone quality.

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Acknowledgments

Funding for the TBS software was provided by the Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, New York. The authors thank Joseph A. Spadaro, PhD for his contribution to preliminary analysis of the study.

Conflicts of interest

None.

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Authors and Affiliations

  1. Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
    R. Dhaliwal, R. S. Weinstock & A. M. Moses
  2. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
    D. Cibula & C. Ghosh
  3. Department of Mathematics, SUNY College at Buffalo, Buffalo, NY, USA
    C. Ghosh

Authors

  1. R. Dhaliwal
  2. D. Cibula
  3. C. Ghosh
  4. R. S. Weinstock
  5. A. M. Moses

Corresponding author

Correspondence toR. Dhaliwal.

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Dhaliwal, R., Cibula, D., Ghosh, C. et al. Bone quality assessment in type 2 diabetes mellitus.Osteoporos Int 25, 1969–1973 (2014). https://doi.org/10.1007/s00198-014-2704-7

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