Effect of diabetes on BMD and TBS values as determinants of bone health in the elderly: Bushehr Elderly Health program

Abstract

Background Considering the aging population associated with higher osteoporotic fracture risk, high prevalence of diabetes and its effect on bone health along with lack of information on bone quality using common methods (BMD) the aim of present study was to determine the association between trabecular bone score (TBS) and diabetes in an elderly population participating in Bushehr Elderly Health (BEH) program. Materials and methods This cross-sectional study was performed on data collected during the BEH Program, stage II. Anthropometric indices were measured based on NHANES III protocol. Diabetes and pre-diabetes were defined according to ADA Guideline 2018. Bone density was measured using DXA method (DXA, Discovery WI, Hologic Inc., USA). A software installed on the same device (TBS iNsight® software) was applied to assess TBS values. Variables related to bone health were compared based on their glycemic status (participants with diabetes, participants with prediabetes, and normoglycemic) using analysis of variance. Univariate and multivariate linear and logistic regression models were used to determine the association between TBS values and bone density in different glycemic states. Results The data of 2263 participant aged 60 years and over were analyzed. Mean TBS values were significantly different between participants with diabetes, participants with prediabetes, and normoglycemic groups (P = 0.004;, however, P trend was not significant (0.400)). Mean BMD values at femoral neck and lumbar spine were significantly higher in diabetics compared with those diagnosed with pre-diabetes; the latter also had higher bone density compared with normoglycemic individuals (both P ANOVA test and P trends for means were < 0.01]. In univariate linear regression model, TBS values were negatively associated with pre-diabetes (β = −0.070; P < 0.001) but not with diabetes (β = −0.002, P = 0.915). This significant relationship disappeared when the results were adjusted for BMI. In fully adjusted multivariate logistic regression models, odds ratio linking pre-diabetes and diabetes with spinal osteoporosis was 0.861 (CI 95% 0.670-1.105) and 0.525 (CI 95% 0.392-0.701), respectively. As for femoral osteoporosis, odds ratio was 0.615 (CI 95% 0.407-0.928) and 0.968 (CI 95% 0.629-1.489), correspondingly. Moreover, for cumulative osteoporosis, the odds were 0.843 (CI 95% 0.676-1.106) and 0.551 (CI 95% 0.415-0.732), respectively.

The reference value of trabecular bone score (TBS) in the Iranian population

“…It may be explained by the higher speed of decrease in bone quality with increasing age in women than men [16]. Also, this correlation is higher than the study of L. M. Del Rio et al [13] which may be due to the sampling of our study, in that the subjects with health conditions such as diabetes that could cause discrepancies between LS-BMD and TBS were excluded [26].…”

Associations of Sex Hormone-binding Globulin with Bone Mineral Density Among US Adults, NHANES 2013–2016

“…FBG did not appear to be associated with lumbar BMD, pelvic BMD and total BMD whether we have adjusted for confounding factors ( p >0.05, Tables 3 – 5 ), which is not consistent with previous studies. 18–20 …”

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 ].…”

“…These results are consistent with a cross-sectional study conducted on 477 diabetic and control participants that showed TBS could better discriminate patients with diabetes who are concomitantly undergoing glucocorticoid therapy from the control population than BMD [ 16 ]. However, a study by Ebrahimpour et al on 2263 subjects showed that despite increased BMD values in diabetic patients, the quality of bone microarchitecture assessed by TBS did not significantly differ from non-diabetic subjects [ 17 ]. Hence, it remains to be evaluated whether TBS as a BMD-independent parameter could be used for the assessment of bone strength in diabetic patients.…”