Assessment of bone quality with trabecular bone score in type 2 diabetes mellitus: A study from the FRISBEE cohort

Abstract

Objective The purpose of our study was to compare bone mineral density (BMD) and trabecular bone score (TBS) values between patients with type 2 diabetes (T2D) and control subjects with similar FRAX scores in order to evaluate TBS as an additional tool for assessing fracture risk in diabetic subjects. Methods A cross‐sectional analysis was performed using BMD results from 260 subjects participating in the FRISBEE study (Fracture RISk Brussels Epidemiological Enquiry), an ongoing prospective epidemiological study in a population‐based cohort (Brussels, Belgium) of 3560 postmenopausal women aged 60‐85 years. TBS measurement was possible in 1108 subjects from the FRISBEE cohort. Among these 1108 subjects, 65 had known T2D at inclusion. For each diabetic case we selected 3 controls from our database. (n = 195). Diabetic subjects and controls were matched for age and baseline FRAX score for major osteoporotic fractures. Results BMD (g/cm2) tended to be higher in T2D than in control subjects, significantly so at the total hip 0.90 ± 0.13 versus 0.87 ± 0.12 (P = 0.015). On the contrary, TBS was significantly lower in the T2D group (mean = 1.19 ± 0.17) compared with the control group (mean = 1.27 ± 0.13) (P = 0.005). Mean TBS remained significantly lower in T2D (1.22 ± 0.17) compared with the control group (1.27 ± 0.13) (P = 0.02) after adjustment for body mass index. Conclusion Our data suggest that TBS complements BMD at the total hip, in demonstrating the “diabetes‐associated bone disease”.

Nutrient Intake Prior to Exercise Is Necessary for Increased Osteogenic Marker Response in Diabetic Postmenopausal Women

“…Postmenopausal estrogen decline leads to bone mineral loss, and lower bone mineral density (BMD) leads to osteopenia and osteoporosis [1] with an associated increase in bone fractures [2]. T2D produces a different effect in that it increases the risk of bone fractures [3] independently of bone mineral density [4,5] apparently due to a deficit in bone quality [5]. While the reasons for changes in diabetic bone quality are not fully understood, they could be a consequence of advanced glycation end products or other pathologies [6], but may also be the result of reduced nutrient access to the bone tissue due to systemic insulin resistance [7], the key characteristic of T2D [8].…”

Bone mineral density in diabetes and impaired fasting glucose

“…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]. Additionally, other studies have reported impaired microarchitecture in individuals with diabetes using HR-pQCT.…”

Summary of the draft federal clinical guidelines for osteoporosis

“…Уровень убедительности рекомендации А (уровень достоверности доказательств 1) Recommendation 3.1: It is recommended to increase an individual 10-year probability of major osteoporotic fracture (FRAX) by 15% if individuals have taken glucocorticoids for 3 months or more at a dose of prednisolone 7.5 mg / day or its equivalent [1,[30][31][32]. A1 РЕКОМЕНДАЦИЯ 3.2: При проведении оценки индивидуальной 10-летней вероятности FRAX у лиц с сахарным диабетом 2 типа рекомендуется провести коррекцию полученного результата, добавив дополнительный риск, ассоциированный с ревматоидным артритом (поставить «да» для данного фактора риска) или ввести результаты исследования трабекулярного костного индекса (ТКИ) [33][34][35].…”

“…Уровень убедительности рекомендации B (уровень достоверности доказательств 3) Recommendation 3.2: When assessing the individual 10-year probability of fracture (FRAX) in people with type 2 diabetes, it is recommended to correct the result by considering the patient to have rheumatoid arthritis (put "yes" for this risk factor) or enter the results of trabecular bone score (TBS) [33][34][35]. B3 РЕКОМЕНДАЦИЯ 4: Проведение двухэнергетической рентгеноденситометрии (DXA) поясничного отдела позвоночника и проксимального отдела бедренной кости рекомендовано лицам с индивидуальной 10-летней вероятностью основных патологических переломов (FRAX) в интервале между низкой и высокой вероятностью переломов (оранжевая зона Рисунок 1) для диагностики остеопороза; пациентам с остеопорозом для оценки эффективности проводимой терапии, а также динамики состояния МПК у пациентов с ранее установленным остеопорозом с перерывом в лечении с временным интервалом не менее 12 месяцев от первого исследования [36][37][38][39][40][41].…”