Type 2 diabetes is associated with fracture risk but, paradoxically, greater bone mineral density. The trabecular bone score (TBS) has been proposed as an index of bone microarchitecture associated with bone quality. This study compared the performance of TBS, bone mineral density (BMD), original and TBS adjusted FRAX scores in the prediction of vertebral fractures (VFs) in diabetic patients. This cross-sectional study enrolled 169 Korean postmenopausal diabetic women. Lateral plain radiographs of the thoracolumbar spine were taken. Lumbar spine and femur neck BMDs were obtained using dual-energy X-ray absorptiometry (DXA). TBS was obtained using the TBS iNsight Software program with BMD DXA images. VFs were diagnosed when at least one of the three height measurements was decreased by >25% compared to the nearest uncompressed vertebral body. Among the subjects, 34 women (20.1%) had VFs. Significantly lower TBS (P=0.008) and higher TBS adjusted FRAX scores were evident for major fractures (P=0.019) in the group with VFs compared to the group without VFs. In contrast, there were no significant differences in BMD and original FRAX scores between the two groups. Odds ratios for VFs for TBS in the lowest quartile (vs highest quartile reference) was the highest (OR 5.5, 95% CI: 1.1=27.7) compared to other parameters even after adjustment for age. These results suggest that TBS and TBS adjusted FRAX could be more useful than BMD to predict osteoporotic fractures in postmenopausal diabetic women.
Keywords: Vertebral fracture, Type 2 diabetes mellitus, Trabecular bone score, FRAX
14 May 2016 - 17 May 2016