Background: Fracture risk is increased in Type 2 diabetes (T2D) individuals. Bone mineral density (BMD) is inversely associated with fracture risk but paradoxically high in T2D individuals. Trabecular bone score (TBS) reflects bone microarchitecture and predicts fracture risk.
Objective: We aimed to compare mean lumbar spine TBS (LS-TBS) and lumbar spine BMD (LS-BMD) values, across individuals with and without i) vertebral fracture (VFx), ii) T2D; and iii) estimate the relation between T2D and VFx risk.
Methods: Our study is embedded within a prospective cohort, among subjects aged ≥55 years. LS-TBS and LS-BMD were derived from dual energy X-ray absorptiometry scans (DEXA) whereas vertebral fractures from X-ray measurements. VFx were scored using the quantitative morphometry method (QM) and algorithm-based qualitative method (ABQ). T2D was defined as fasting serum glucose levels higher than 7.0 mmol/l or being on antidiabetic treatment. Multivariate linear and logistic regression models adjusted for age, sex, height and body mass index were used.
Results: Among 4062 participants included in our study, 513 were classified as T2D and 744 had prevalent VFx. Both LS-TBS and LS-BMD were negatively associated with VFx. LS-TBS (OR=0.113, 95% CI 0.0450.28, P<0.001) and LS-BMD (OR=0.46, CI 0.24 0.68, P=0.005). T2D was negatively associated with LS-TBS (β=−0.063, CI −0.034 to −0.0110, P<0.001) whereas it was positively associated with LS-BMD (β=0.07, CI 0.0250.064, P<0.001). There was no association between T2D and vertebral fracture risk (OR=1.067 CI 0.8281.375, P=0.61).
Conclusion: LS-TBS was positively associated with T2D and negatively associated with VFx, despite a higher BMD in diabetics. Our results suggest that LS-TBS may be an indicator of fracture risk despite the higher BMD values in individuals with T2D.
14 May 2016 - 17 May 2016