Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study

Palomo, Telma; Dreyer, Patrícia; Muszkat, Patricia; Weiler, Fernanda Guimarães; Bonansea, Teresa Cristina Piscitelli; Domingues, Fernanda; Vieira, José Gilberto H.; Silva, Barbara C.; Brandão, Cynthia

doi:10.1016/j.bone.2022.116339

Cited by 11 publications

(18 citation statements)

References 50 publications

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“…For men, the thresholds are 1.258 and 1.338, while for women 1.267 and 1.347. TBS tertiles reported for Brazilian elderly women are similar to those proposed for Latin American women ( 45 ).…”

Section: Application Of Tbs In Guiding Clinical Decisionssupporting

confidence: 76%

“…Several studies (42,57,(112)(113)(114)(115)(116)(117), but not all (58,111), have shown that TBS is lower in patients with diabetes, especially in those with poor glycemic control, disease complications, and/or longer duration of disease. This discrepancy could also be attributed to the differences in sample size, duration of diabetes, HbA1c levels, and multifactorial pathophysiology of bone fragility in diabetes, which demands further investigation (45,57,59,61). Recently, our research group reported that the effect of abdominal soft tissue thickness (STT) should be considered when interpreting TBS in patients with T2D in whom increased abdominal adiposity may artifactually reduce TBS values (45).…”

Section: Diabetesmentioning

confidence: 99%

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Update on trabecular bone score

Palomo¹,

Muszkat²,

Weiler³

et al. 2022

Archives of Endocrinology and Metabolism

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Trabecular bone score (TBS) is an indirect and noninvasive measure of bone quality. A low TBS indicates degraded bone microarchitecture, predicts osteoporotic fracture, and is partially independent of clinical risk factors and bone mineral density (BMD). There is substantial evidence supporting the use of TBS to assess vertebral, hip, and major osteoporotic fracture risk in postmenopausal women, as well as to assess hip and major osteoporotic fracture risk in men aged > 50 years. TBS complements BMD information and can be used to adjust the FRAX (Fracture Risk Assessment) score to improve risk stratification. While TBS should not be used to monitor antiresorptive therapy, it may be potentially useful for monitoring anabolic therapy. There is also a growing body of evidence indicating that TBS is particularly useful as an adjunct to BMD for fracture risk assessment in conditions associated with increased fracture risk, such as type-2 diabetes, chronic corticosteroid excess, and other conditions wherein BMD readings are often misleading. The interference of abdominal soft tissue thickness (STT) on TBS should also be considered when interpreting these findings because image noise can impact TBS evaluation. A new TBS software version based on an algorithm that accounts for STT rather than BMI seems to correct this technical limitation and is under development. In this paper, we review the current state of TBS, its technical aspects, and its evolving role in the assessment and management of several clinical conditions.

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Section: Application Of Tbs In Guiding Clinical Decisionssupporting

confidence: 76%

Section: Diabetesmentioning

confidence: 99%

Update on trabecular bone score

Palomo¹,

Muszkat²,

Weiler³

et al. 2022

Archives of Endocrinology and Metabolism

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“…A recent meta-analysis demonstrated lower TBS in women (but not men) with T2D [27]. A subsequent study in postmenopausal women found that greater abdominal soft-tissue thickness in T2D may partially explain lower TBS because of its effect on soft tissue ‘noise’ [28]. TBS is predictive of osteoporotic fractures independent of FRAX clinical risk factors and femoral neck BMD, and can be used to adjust the FRAX score in order to improve fracture risk prediction [29].…”

Section: Fracture Risk Prediction Tools and Performance In Individual...mentioning

confidence: 99%

Fracture prediction tools in diabetes

Agarwal

Leslie

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewType 1 (T1D) and 2 diabetes (T2D) are associated with increased risk of fracture independent of bone mineral density (BMD). Fracture risk prediction tools can identify individuals at highest risk, and therefore, most likely to benefit from antifracture therapy. This review summarizes recent advances in fracture prediction tools as applied to individuals with diabetes. Recent findingsThe Fracture Risk Assessment (FRAX) tool, Garvan Fracture Risk Calculator (FRC), and QFracture tool are validated tools for fracture risk prediction. FRAX is most widely used internationally, and considers T1D (but not T2D) under secondary osteoporosis disorders. FRAX underestimates fracture risk in both T1D and T2D. Trabecular bone score and other adjustments for T2D-associated risk improve FRAX-based estimations. Similar adjustments for T1D are not identified. Garvan FRC does not incorporate diabetes as an input but does includes falls. Garvan FRC slightly underestimates osteoporotic fracture risk in women with diabetes. QFracture incorporates both T1D and T2D and falls as input variables, but has not been directly validated in individuals with diabetes. SummaryFurther research is needed to validate and compare available fracture prediction tools and their performance in individuals with diabetes.

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“…Bone fragility in diabetes results, not only from alterations in bone mineralization, but also from alterations in bone microstructure [ 19 ] that can be indirectly assessed by TBS. Nearly all the subjects included in our study were overweight or obese, so higher BMD and lower TBS are influenced by higher BMI [ 52 , 53 ], which leads to errors in DXA measurements caused by soft tissue thickness [ 54 ]. Therefore, we included controls with a comparable BMI distribution to our study’s population.…”

Section: Discussionmentioning

confidence: 99%

Reduced High-Density Lipoprotein Cholesterol Is an Independent Determinant of Altered Bone Quality in Women with Type 2 Diabetes

Dule

Barchetta

Cimini

et al. 2023

IJMS

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Type 2 diabetes mellitus (T2DM) is associated with an increased fracture risk. Our study aimed to explore differences in bone alterations between T2DM women and controls and to assess clinical predictors of bone impairment in T2DM. For this observational case control study, we recruited 126 T2DM female patients and 117 non-diabetic, age- and BMI-comparable women, who underwent clinical examination, routine biochemistry and dual-energy X-ray absorptiometry (DXA) scans for bone mineral density (BMD) and trabecular bone score (TBS) assessment-derived indexes. These were correlated to metabolic parameters, such as glycemic control and lipid profile, by bivariate analyses, and significant variables were entered in multivariate adjusted models to detect independent determinants of altered bone status in diabetes. The T2DM patients were less represented in the normal bone category compared with controls (5% vs. 12%; p = 0.04); T2DM was associated with low TBS (OR: 2.47, C.I. 95%: 1.19–5.16, p = 0.016) in a regression model adjusted for age, menopausal status and BMI. In women with T2DM, TBS directly correlated with plasma high-density lipoprotein cholesterol (HDL-c) (p = 0.029) and vitamin D (p = 0.017) levels. An inverse association was observed with menopausal status (p < 0.001), metabolic syndrome (p = 0.014), BMI (p = 0.005), and waist circumference (p < 0.001). In the multivariate regression analysis, lower HDL-c represented the main predictor of altered bone quality in T2DM, regardless of age, menopausal status, BMI, waist circumference, statin treatment, physical activity, and vitamin D (p = 0.029; R2 = 0.47), which likely underlies common pathways between metabolic disease and bone health in diabetes.

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Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study

Cited by 11 publications

References 50 publications

Update on trabecular bone score

Update on trabecular bone score

Fracture prediction tools in diabetes

Reduced High-Density Lipoprotein Cholesterol Is an Independent Determinant of Altered Bone Quality in Women with Type 2 Diabetes

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