Diabetes is associated with increased risk of fracture, although type 2 diabetes mellitus (T2DM) is characterized by normal bone mineral density (BMD). Thus, diabetes may be associated with a reduction of bone strength that is not reflected in the measurement of BMD. It is very problematic to measure the bone quality in daily practice. Trabecular bone score (TBS) iNsight® is one of these tools, now available for routine clinical practice, that allows for refinement of micro architecture and fracture risk, independent of BMD.
Objective: TBS evaluation of increased fracture risk in T2DM vs control group of patient without DM.
Patients and methods: Retrospective study, 56 postmenopausal women patients with T2DM and 61 women patient without DM or IGT. We evaluated the ability of lumbar spine TBS to account the increased risk of fractures in T2DM.
Results: Mean age of the patients with T2DM was 67.5±9.1, mean BMI 29.7±6.1. Diabetes was associated with higher BMD the T-score of LS was −0.8±1.5 and of the HIP −0.7±1.3, while in the group without DM T-score of LS was −1.2±1.5, and of the HIP −1.1±1.1. Fractures occurred in 16.3% patients with T2DM (13.3% in patient without DM, P<0.05). The diabetic patient has lower lumbar spine TBS (1.172±0.133). Least squares mean (LSM) for BMD were significant greater in women with T2DM than without, whereas LSM for TBS-LS was significant lower in T2DM. The adjusted odds ratio for a measurement in the lowest vs highest tertile was <1 for BMD (all P<0.001), but was increased for TBS-LS (OR 2.41). TBS was a BMD-independent predictor of fracture in those with diabetes.
Conclusion: TBS together with BMD helps to provide better information about real bone status and bone micro architecture in patients with T2DM. TBS is a promising tool to identify patient with T2DM in higher risk of osteoporotic fracture. To identify these patients in daily clinical practice is the basic for effective treatment.
17 May 2014 - 20 May 2014