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TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk
Journal article

TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk

  • Leslie, William D. Department of Medicine (W.D.L.), University of Manitoba, Winnipeg, Canada R2H 2A6
  • Aubry-Rozier, Berengère Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland
  • Lamy, Olivier Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland
  • Hans, Didier Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland
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Published in:
  • The Journal of Clinical Endocrinology & Metabolism. - The Endocrine Society. - 2013, vol. 98, no. 2, p. 602-609
Clinical Biochemistry
Biochemistry
Endocrinology, Diabetes and Metabolism
Endocrinology
Biochemistry, medical
English Abstract

Context:
Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD.


Objective:
This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes.


Design and Setting:
We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada.


Patients:
We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes.


Main Outcome Measures:
Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years).


Results:
Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30–2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10–1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24–1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements.


Conclusions:
Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/293629
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