Skip to main content

Advertisement

SpringerLink
Log in

Bone quality assessment in type 2 diabetes mellitus

  • Short Communication
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The increased risk for fractures in type 2 diabetes mellitus (T2DM) despite higher average bone density is unexplained. This study assessed trabecular bone quality in T2DM using the trabecular bone score (TBS). The salient findings are that TBS is decreased in T2DM and low TBS associates with worse glycemic control.

Introduction

Type 2 diabetes mellitus is a risk factor for osteoporotic fractures despite high average bone mineral density (BMD). The aim of this study was to compare BMD with a noninvasive assessment of trabecular microarchitecture, TBS, in women with T2DM.

Methods

In a cross-sectional study, trabecular microarchitecture was examined in 57 women with T2DM and 43 women without diabetes, ages 30 to 90 years. Lumbar spine BMD was measured by dual-emission x-ray absorptiometry (DXA), and TBS was calculated by examining pixel variations within the DXA images utilizing TBS iNsight software.

Results

Mean TBS was lower in T2DM (1.228 ± 0.140 vs. 1.298 ± 0.132, p = 0.013), irrespective of age. Mean BMD was higher in T2DM (1.150 ± 0.172 vs. 1.051 ± 0.125, p = 0.001). Within the T2DM group, TBS was higher (1.254 ± 0.148) in subjects with good glycemic control (A1c ≤ 7.5 %) compared to those (1.166 ± 0.094; p = 0.01) with poor glycemic control (A1c > 7.5 %).

Conclusion

In T2DM, TBS is lower and associated with poor glycemic control. Abnormal trabecular microarchitecture may help explain the paradox of increased fractures at a higher BMD in T2DM. Further studies are needed to better understand the relationship between glycemic control and trabecular bone quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16(5):447–455

    Article  PubMed  Google Scholar 

  2. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. report of a WHO study group. World Health Organ Tech Rep Ser 1994; 843:1–129

    Google Scholar 

  3. Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD (2007) Low bone mineral density and fracture burden in postmenopausal women. CMAJ 177(6):575–580

    Article  PubMed Central  PubMed  Google Scholar 

  4. Stone KL, Seeley DG, Lui LY et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18(11):1947–1954

    Article  PubMed  Google Scholar 

  5. Rice JC, Cowin SC, Bowman JA (1988) On the dependence of the elasticity and strength of cancellous bone on apparent density. J Biomech 21(2):155–168

    Article  CAS  PubMed  Google Scholar 

  6. DalleCarbonare L, Giannini S (2004) Bone microarchitecture as an important determinant of bone strength. J Endocrinol Invest 27(1):99–105

    Article  CAS  Google Scholar 

  7. Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the nurses’ health study. Diabetes Care 29(7):1573–1578

    Article  PubMed  Google Scholar 

  8. Strotmeyer ES, Cauley JA, Schwartz AV et al (2005) Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. Arch Intern Med 165(14):1612–1617

    Article  PubMed  Google Scholar 

  9. Melton LJ 3rd, Riggs BL, Leibson CL et al (2008) A bone structural basis for fracture risk in diabetes. J Clin Endocrinol Metab 93(12):4804–4809

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. de Liefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA (2005) Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam study. Osteoporos Int 16(12):1713–1720

    Article  PubMed  Google Scholar 

  11. Giangregorio LM, Leslie WD, Lix LM et al (2012) FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 27(2):301–308

    Article  PubMed  Google Scholar 

  12. Bousson V, Bergot C, Sutter B, Levitz P, Cortet B (2012) Scientific Committee of the Groupe de Recherche et d’Informationsur les Osteoporoses. Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects. Osteoporos Int 23(5):1489–1501

    Article  CAS  PubMed  Google Scholar 

  13. Roux JP, Wegrzyn J, Boutroy S, Bouxsein ML, Hans D, Chapurlat R (2013) The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study. Osteoporos Int 24(9):2455–2460

    Article  CAS  PubMed  Google Scholar 

  14. Pothuaud L, Carceller P, Hans D (2008) Correlations between grey-level variations in 2D projection images (TBS) and 3D microarchitecture: applications in the study of human trabecular bone microarchitecture. Bone 42(4):775–787

    Article  PubMed  Google Scholar 

  15. Hans D, Goertzen AL, Krieg MA, Leslie WD (2011) Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res 26(11):2762–2769

    Article  PubMed  Google Scholar 

  16. Breban S, Briot K, Kolta S et al (2012) Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score. J Clin Densitom 15(3):260–266

    Article  PubMed  Google Scholar 

  17. Winzenrieth R, Dufour R, Pothuaud L, Hans D (2010) A retrospective case-control study assessing the role of trabecular bone score in postmenopausal Caucasian women with osteopenia: analyzing the odds of vertebral fracture. Calcif Tissue Int 86(2):104–109

    Article  CAS  PubMed  Google Scholar 

  18. Leslie WD, Rubin MR, Schwartz AV, Kanis JA (2012) Type 2 diabetes and bone. J Bone Miner Res 27(11):2231–2237

    Article  PubMed  Google Scholar 

  19. Burghardt AJ, Issever AS, Schwartz AV et al (2010) High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 95(11):5045–5055

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Leslie WD, Aubry-Rozier B, Lamy O, Hans D (2013) Manitoba Bone Density Program. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab 98(2):602–609

    Article  CAS  PubMed  Google Scholar 

  21. Ma L, Oei L, Jiang L, Estrada K, Chen H, Wang Z (2012) Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol 27(5):319–332

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for the TBS software was provided by the Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, New York. The authors thank Joseph A. Spadaro, PhD for his contribution to preliminary analysis of the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA

    R. Dhaliwal, R. S. Weinstock & A. M. Moses

  2. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA

    D. Cibula & C. Ghosh

  3. Department of Mathematics, SUNY College at Buffalo, Buffalo, NY, USA

    C. Ghosh

Authors
  1. R. Dhaliwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Cibula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. S. Weinstock
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. M. Moses
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Dhaliwal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dhaliwal, R., Cibula, D., Ghosh, C. et al. Bone quality assessment in type 2 diabetes mellitus. Osteoporos Int 25, 1969–1973 (2014). https://doi.org/10.1007/s00198-014-2704-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-014-2704-7

Keywords

Search

Navigation