Abstract
BackgroundDespite having higher bone mineral density (BMD) values, type 2 diabetes mellitus (T2DM) patients are at increased risk of fracture. Trabecular bone score (TBS) obtained by evaluating bone microarchitecture might be a more accurate factor for determining bone strength in T2DM patients. In this study, we aimed at investigating the mean values of lumbar spine (LS) TBS, LS-BMD, and femoral neck BMD in T2DM patients and controls, as well as the ability of LS-TBS and BMD in distinguishing between T2DM patients and controls.MethodsThis case-control study was conducted on 150 patients with T2DM (129 women, 21 men) and 484 controls (424 women, 60 men) in Tehran, Iran. LS-TBS along with femoral neck BMD and LS-BMD was computed using dual-energy X-ray absorptiometry images. Diagnostic accuracy and discriminative capacity of LS-TBS, femoral neck BMD, and LS-BMD between the case and control groups were assessed.ResultsT2DM patients showed significantly lower LS-TBS values compared to the control group in the total population and in women. However, in T2DM patients, femoral neck BMD and LS-BMD were found to be significantly higher in the total population and in men, respectively, compared to the control group. Based on area under the curve (AUC) and after adjusting for age and BMI, TBS, LS-BMD, and femoral neck BMD were shown to have the acceptable ability in distinguishing T2DM patients and controls.ConclusionBesides higher BMD and lower TBS values in T2DM patients compared to controls, a similar acceptable discriminative ability of LS-TBS, LS-BMD, and femoral neck BMD in differentiating between T2DM patients and controls was observed in the total population and in women.
Highlights
Despite having higher bone mineral density (BMD) values, type 2 diabetes mellitus (T2DM) patients are at increased risk of fracture
We aimed at investigating the mean values of lumbar spine (LS) Trabecular bone score (TBS), LS-BMD, and femoral neck BMD in T2DM patients and controls, as well as the ability of LS-TBS and BMD in distinguishing between T2DM patients and controls in both male and female populations in Tehran, Iran
Two meta-analyses including 7,832,213 subjects demonstrated a higher risk of hip fractures in diabetic patients in comparison to the general population [1, 2]. These findings suggest that diabetes through different mechanisms may have a direct adverse effects on bone strength, which cannot be reflected by BMD alone [11, 13]
Summary
Despite having higher bone mineral density (BMD) values, type 2 diabetes mellitus (T2DM) patients are at increased risk of fracture. Trabecular bone score (TBS) obtained by evaluating bone microarchitecture might be a more accurate factor for determining bone strength in T2DM patients. Despite T2DM patients’ increased susceptibility to fracture compared to non-diabetics, there are many studies demonstrating higher mean BMD values in T2DM patients [6,7,8], suggesting an underestimation of osteoporosis in T2DM patients [9]. Bone microarchitecture (as a component of bone quality) can be evaluated using the trabecular bone score (TBS), a noninvasive gray-level texture parameter that is widely used and cost-effective and calculated based on DXA images previously obtained for determining BMD [12, 13]. Higher values of TBS are consistently associated with an increase in bone strength and fracture-resistant microarchitecture, and lower values indicate weak, fractureprone structure [12, 13, 15]
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