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

Abstract

Background Despite having higher bone mineral density (BMD) values, type 2 diabetes mellitus (T2DM) patients are at increased risk of fracture. Trabecular bone score (TBS) obtained by evaluating bone microarchitecture might be a more accurate factor for determining bone strength in T2DM patients. In this study, we aimed at investigating the mean values of lumbar spine (LS) TBS, LS-BMD, and femoral neck BMD in T2DM patients and controls, as well as the ability of LS-TBS and BMD in distinguishing between T2DM patients and controls. Methods This case-control study was conducted on 150 patients with T2DM (129 women, 21 men) and 484 controls (424 women, 60 men) in Tehran, Iran. LS-TBS along with femoral neck BMD and LS-BMD was computed using dual-energy X-ray absorptiometry images. Diagnostic accuracy and discriminative capacity of LS-TBS, femoral neck BMD, and LS-BMD between the case and control groups were assessed. Results T2DM patients showed significantly lower LS-TBS values compared to the control group in the total population and in women. However, in T2DM patients, femoral neck BMD and LS-BMD were found to be significantly higher in the total population and in men, respectively, compared to the control group. Based on area under the curve (AUC) and after adjusting for age and BMI, TBS, LS-BMD, and femoral neck BMD were shown to have the acceptable ability in distinguishing T2DM patients and controls. Conclusion Besides higher BMD and lower TBS values in T2DM patients compared to controls, a similar acceptable discriminative ability of LS-TBS, LS-BMD, and femoral neck BMD in differentiating between T2DM patients and controls was observed in the total population and in women.

Higher BMI and lower femoral neck strength in males with type 2 diabetes mellitus and normal bone mineral density

“…8 DXA is also used for the diagnosis of osteoporosis. 16 Femoral neck and lumbar spine BMDs were found to be significantly higher in total population and males with T2DM, 17 In clinical practice, the risk of fracture is particularly overlooked in diabetic patients with normal BMD, especially in male patients with obesity. Analyzing fracture risk and BMD alone lacks sensitivity .…”

Preptin: A New Bone Metabolic Parameter?

“…The bone deleterious effects of insulinopenia are very-well seen in type 1 diabetes mellitus (T1D), where low bone mass accrual is seen after disease onset [ 28 ]. T2M patients are reported to have increased BMD [ 29 ], probably due to increased BMI, which is a protective factor against osteoporosis in all populations due to the mechanical loading [ 30 ]. Our group also found BMI to be a positive independent predictor in T2M [ 31 ].…”

“…Hyperinsulinism secondary to insulin resistance may contribute to this finding. However, cortical bone microarchitecture is altered in T2M patients [ 32 ], which exhibit reduced trabecular bone score despite increased BMD [ 29 ]. In advanced disease, microvascular damage, insulinopenia and visceral adiposity negatively impact bone mass and turnover [ 26 ].…”

Imaging techniques to study diabetic bone disease

“…women) and without T2D (n ¼ 484, age ¼ 58.5 AE 13.0 years; 87.6% women), although subjects with T2D showed significantly lower TBS compared to controls in the total population and in women, TBS showed similar discriminative capabilities than lumbar spine and femoral neck aBMD in differentiating subjects with and without T2D in the total population and in women (area under the curve [AUC] $ ¼ 0.64) [12].…”

“…The authors of the study also reported that differences in TBS between subjects with and without T2D were not independent of lumbar spine aBMD in men and women regardless of the degree of T2D control, except between well controlled T2D and non-T2D women (higher TBS in well controlled T2D women). Furthermore, in a recent cross-sectional study by Delbari et al between subjects with ( n = 150, age = 62.5 ± 10.2 years; 86% women) and without T2D ( n = 484, age = 58.5 ± 13.0 years; 87.6% women), although subjects with T2D showed significantly lower TBS compared to controls in the total population and in women, TBS showed similar discriminative capabilities than lumbar spine and femoral neck aBMD in differentiating subjects with and without T2D in the total population and in women (area under the curve [AUC] ∼ = 0.64) [12].…”