Bone mineral density and trabecular bone score in elderly type 2 diabetes Southeast Asian patients with severe osteoporotic hip fractures

Abstract

Introduction Studies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences. Methods We conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014–2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2. Results Elderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women—poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures. Conclusions Elderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis.

Around the time of a hip fracture, older East Asian female patients tend to measure lower densitometric femoral neck and total hip T-scores than older Caucasian female patients: a literature analysis

“…For male patients, only a 'possible' trend is noted that East Asian patients measure lower total hip T-scores. Another point noted is that, around the timepoint of a hip fracture, at least for East Asians included in this study, male patients tend to measure higher femoral neck and total hip T-scores than those of female patients (Figure 4) (24,28,29,30,32,33). .…”

“…For the data in the articles included for analysis, the results are shown in Figure 1 for female patients (24)(25)(26)(27)(28)(29)(30)(31)(32)(33), Figure 2 for male and female patients mixed (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and Figure 3 for male patients (24,(28)(29)(30)32,33,46,47). For the data in Figure 2, females commonly constituted 2/3 of the cases, reflecting that hip fracture prevalence among older women is about double of that among older men.…”

“…Figure 4In total six studies reported both males' data and females' data(24,(28)(29)(30)32,33), data from all four East Asian cohorts show FN and TH T-scores of proximal femur fracture male patients measure higher than those of female patients. A trend for data of Caucasians can not be ascertained.…”

A comparison between femoral neck and LS-BMD with LS-TBS in T2DM patients: a case control study

“…However, there is evidence showing higher TBS values among T2DM patients than controls [ 20 ] as well as evidence showing no significant difference in this regard, despite significant higher values of BMD among diabetics, for example, a case-control study by Zhukouskaya et al on 99 diabetic patients and 107 controls showing that TBS values were not significantly different among DM patients and controls; however, it was lower in patients with DM who suffered fractures [ 21 ]. Another population-based study among the Iranian population consisting of 2263 participants aged 60 years and above also showed that mean TBS values were not significantly different among diabetics and normoglycemics [ 17 ].…”

Relationship between Oral Health Status and Bone Mineral Density in Community-Dwelling Elderly Individuals: A Cross-Sectional Study

“…Furthermore, the fewer the number of remaining teeth, the lower the masticatory function; hence, the results of this study can be considered consistent [ 37 ]. These results suggest that the target population of this study can be representative of the general population with a common pathology, considering tooth loss due to periodontal disease and the association between diabetes and periodontal disease and between diabetes and bone mineral density [ 38 , 39 ].…”