Trabecular Bone Score in Men and Women with Impaired Fasting Glucose and Diabetes

Holloway, Kara L.; Abreu, Lélia Lelis Ferreira de; Hans, Didier; Kotowicz, Mark A.; Sajjad, Muhammad A.; Hyde, Natalie K.; Pasco, Julie A.

doi:10.1007/s00223-017-0330-z

Cited by 36 publications

(27 citation statements)

References 34 publications

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“…(31,32) Second, we used the TBS adjustment to the FRAX score; this is justified by the observation in several studies that TBS is lower in those with type 2 diabetes than in the general population. (33)(34)(35)(36)(37) Initially, the TBS adjustment was applied to patients with diabetes because the TBS adjustment to FRAX was developed and validated for use in the general population; we secondarily considered its effect for the entire population including those without diabetes. (38,39) Third, we reduced the femoral neck T-score input to FRAX by 0.5 SD in patients with diabetes; this follows from the observation that a T-score in a woman with diabetes mellitus is associated with HF risk equivalent to a woman without diabetes mellitus with a T-score of approximately 0.5 units lower.…”

Section: Diabetes Mellitus Case Definition and Risk Adjustmentsmentioning

confidence: 99%

Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry

Leslie¹,

Johansson²,

McCloskey

et al. 2018

Journal of Bone and Mineral Research

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108

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Type 2 diabetes is a risk factor for fracture independent of FRAX (fracture risk assessment) probability. We directly compared four proposed methods to improve the performance of FRAX for type 2 diabetes by: (1) including the rheumatoid arthritis (RA) input to FRAX; (2) making a trabecular bone score (TBS) adjustment to FRAX; (3) reducing the femoral neck T-score input to FRAX by 0.5 SD; and (4) increasing the age input to FRAX by 10 years. We examined major osteoporotic fractures (MOFs) and hip fractures (HFs) over a mean of 8.3 years observation among 44,543 women and men 40 years of age or older (4136 with diabetes) with baseline lumbar spine and hip DXA from 1999 through 2016. Controlled for unadjusted FRAX probability, diabetes was associated with an increased risk for MOFs and HFs. All four FRAX adjustments attenuated the effect of diabetes, but a residual effect of diabetes was seen on MOF risk after TBS adjustment, and on HF risk after the RA and TBS adjustments. Among those with diabetes, unadjusted FRAX risk underestimated MOF (observed/predicted ratio 1.15; 95% CI, 1.03 to 1.28), but this was no longer significant after applying the diabetes adjustments. HF risk was more severely underestimated (observed/predicted ratio 1.85; 95% CI, 1.51 to 2.20) and was only partially corrected with the diabetes adjustments (still significant for the RA and TBS adjustments). Among those with diabetes, there was moderate reclassification based upon a fixed MOF cut-off of 20% (4.1% to 7.1%) or fixed HF cut-off of 3% (5.7% to 16.5%). Net reclassification improvement increased for MOF with each of the diabetes adjustments (range 3.9% to 5.6% in the diabetes subgroup). In conclusion, each of the proposed methods for addressing limitations in the ability of FRAX to assess fracture risk in individuals with diabetes was found to improve performance, though no single method was optimal in all settings. © 2018 American Society for Bone and Mineral Research.

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Section: Diabetes Mellitus Case Definition and Risk Adjustmentsmentioning

confidence: 99%

Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry

Leslie¹,

Johansson²,

McCloskey

et al. 2018

Journal of Bone and Mineral Research

Self Cite

108

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“…Another potential explanation could be related to impaired bone microarchitecture. We have previously reported that although trabecular bone score (TBS) is not different in men and women with IFG compared with normoglycaemia, values for diabetes were lower [36]. Other studies have also reported lower TBS values for individuals with type 2 diabetes [37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 94%

Bone mineral density in diabetes and impaired fasting glucose

et al. 2019

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We report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher lumbar spine bone mineral density (LSBMD). Femoral neck bone mineral density (FNBMD) was higher in obese postmenopausal women with diabetes. Only non-obese post-menopausal women with impaired fasting glucose (IFG) had a higher LSBMD than normoglycaemia. No other associations with IFG were observed. Introduction Individuals with diabetes have a higher or normal bone mineral density (BMD) compared with those without diabetes. However, paradoxically, they also have a higher fracture risk. It is not clear whether those with IFG also have altered BMD. This study aimed to determine whether individuals with IFG have elevated or normal BMD. Methods Women (n = 858) and men (n = 970) (aged 20-80 years) from the Geelong Osteoporosis Study were included. IFG was defined as fasting plasma glucose (FPG) 5.5-6.9 mmol/L and diabetes as FPG ≥ 7.0 mmol/L, use of antihyperglycaemic medication and/or self-report. Using multivariable linear regression, the relationships between glycaemia and BMD at the femoral neck and lumbar spine were examined, and adjusted for age, body mass index (BMI), and other variables. In women, two interaction terms were identified: menopause × glycaemia and BMI × glycaemia, and thus, the analyses were stratified by menopause and obesity status (BMI cut point ≥ 30 kg/m 2). Results There were no associations between glycaemic status and BMD for pre-menopausal women. For non-obese postmenopausal women, there was no association between FNBMD and glycaemic status, but women with IFG or diabetes had higher LSBMD than those with normoglycaemia (7.1% and 9.7%, respectively, both p < 0.01). Obese post-menopausal women with diabetes had a higher FNBMD (8.8%, p = 0.008) and LSBMD (12.2%, p < 0.001), but those with IFG were not different from the normoglycaemia group. There were no associations detected between glycaemic status and BMD in men. Conclusions In this study, we report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher LSBMD. FNBMD was higher in obese post-menopausal women with diabetes. Only non-obese postmenopausal women with IFG had a higher LSBMD than normoglycaemia. No other associations with IFG were observed.

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“…The primary endpoint is baseline to end-of-study change in TBS, based on previous reports showing that it is consistently lower in T2D versus non-diabetic individuals 15–20…”

Section: Methods and Analysismentioning

confidence: 99%

“…Potential pitfalls include the lack of data on TBS change over time in T2D individuals and the impact of exercise on this surrogate measure of bone quality. However, an age-dependent reduction in TBS of up to 0.5%/year has been reported in the general population60–63 and such decrease is likely to be accelerated in patients with T2D, given the large reduction in TBS detected in T2D versus non-diabetic individuals 15–20 64. In addition, in osteoporotic individuals, TBS was shown to be markedly increased (by ~4% in 2–3 years) by osteoanabolic agents such as teriparatide, though less than spine BMD,65–67 whereas antiresorptive agents, which merely increase bone mineralisation, were virtually ineffective 63.…”

Section: Ethics and Disseminationmentioning

confidence: 99%

“…The trabecular bone score (TBS) is a grey-level texture measurement based on two-dimensional projection images acquired during a DXA lumbar spine scan 13. It was consistently found to be reduced in T2D patients with fracture versus those without14 and in T2D versus non-diabetic individuals15–20 and to predict fracture risk independently of BMD 15. Quantitative ultrasound (QUS) provides an estimate of BMD,21 which predicted fracture risk better than DXA-derived BMD in older women with T2D22; in addition, QUS evaluates microarchitecture and material properties 23 24.…”

Section: Introductionmentioning

confidence: 99%

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Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial

et al. 2019

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IntroductionType 2 diabetes (T2D) is associated with an increased fracture risk despite normal-to-increased bone mineral density, suggesting reduced bone quality. Exercise may be effective in reducing fracture risk by ameliorating muscle dysfunction and reducing risk of fall, though it is unclear whether it can improve bone quality.Methods and analysisThe ‘Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in T2D’ is an open-label, assessor-blinded, randomised clinical trial comparing an exercise training programme of 2-year duration, specifically designed for improving bone quality and strength, with standard care in T2D individuals. Two hundred T2D patients aged 65–75 years will be randomised 1:1 to supervised exercise training or standard care, stratified by gender, age ≤ or >70 years and non-insulin or insulin treatment. The intervention consists of two weekly supervised sessions, each starting with 5 min of warm-up, followed by 20 min of aerobic training, 30 min of resistance training and 20 min of core stability, balance and flexibility training. Participants will wear weighted vests during aerobic and resistance training. The primary endpoint is baseline to end-of-study change in trabecular bone score, a parameter of bone quality consistently shown to be reduced in T2D. Secondary endpoints include changes in other potential measures of bone quality, as assessed by quantitative ultrasound and peripheral quantitative CT; bone mass; markers of bone turnover; muscle strength, mass and power; balance and gait. Falls and asymptomatic and symptomatic fractures will be evaluated over 7 years, including a 5-year post-trial follow-up. The superiority of the intervention will be assessed by comparing between-groups baseline to end-of-study changes.Ethics and disseminationThis study was approved by the institutional ethics committee. Written informed consent will be obtained from all participants. The study results will be submitted for peer-reviewed publication.Trial registration numberNCT02421393.

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Trabecular Bone Score in Men and Women with Impaired Fasting Glucose and Diabetes

Cited by 36 publications

References 34 publications

Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry

Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry

Bone mineral density in diabetes and impaired fasting glucose

Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial

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