Elsevier

Journal of Clinical Densitometry

Volume 21, Issue 3, July–September 2018, Pages 355-359
Journal of Clinical Densitometry

Original Article
Trabecular Bone Score Is a Valuable Addition to Bone Mineral Density for Bone Quality Assessment in Older Mexican American Women With Type 2 Diabetes

https://doi.org/10.1016/j.jocd.2018.02.004Get rights and content

Abstract

Altered bone quality due to the underlying metabolic changes of type 2 diabetes (T2D) has been hypothesized to affect bone strength, leading to increased fracture risk in patients with T2D. Lumbar spine trabecular bone score (LS-TBS), an indirect measure of trabecular microarchitecture, provides information on bone quality and has been associated with T2D. However, trabecular bone score (TBS) is also affected by demographic patterns and body size, and is expected to be different in people from various ethnic or racial backgrounds. Therefore, it is important to understand associations between T2D and TBS for each ethnic or racial group separately. Although the relationship between TBS and age has been reported to be similar between non-Hispanic Caucasians and Mexican Americans (MAs), data on associations of LS-TBS with T2D in older MAs are lacking. Here, we report associations between TBS and T2D in 149 older MA men and women. Participants are part of a cohort known as the Cameron County Hispanic Cohort in Texas who have high prevalence of obesity and poor glycemic control. Bone mineral density was not altered for MA women with T2D, but was significantly higher in MA men with T2D compared with MA men without diabetes. Low LS-TBS was associated with T2D in women in our study. Although low TBS was associated with older age in men, TBS did not show any significant association with T2D for men. These results are similar to those found in other studies of non-Hispanic whites with diabetes. LS-TBS may add value in diagnosing poor bone quality in older MA women with T2D regardless of bone mineral density scoring.

Introduction

Dual-energy X-ray absorptiometry (DXA)-acquired bone mineral density (BMD) remains the gold standard for diagnosing osteoporosis and assessing risk of fragility fractures (1). However, a paradoxical presence of fragility fractures with high or normal (nonosteoporotic) BMD in patients with type 2 diabetes (T2D) suggests that DXA may not be reliable for assessing fracture risk in subjects with T2D (2). An altered state of bone quality—caused by underlying metabolic changes of T2D—has been hypothesized to cause reduced strength and bone turnover, leading to increased fracture risk in patients with T2D 2, 3. Trabecular bone score (TBS), an indirect measure of trabecular microarchitecture derived from lumbar spine DXA images, provides information on bone quality based on pixel gray-level variations in the DXA image 4, 5. Previous studies reported that lumbar spine TBS (LS-TBS) was decreased in patients with T2D compared with those without diabetes 6, 7. However, TBS was also reported to be affected by demographic patterns and body size, and thus may be different in people from various ethnic or racial backgrounds (8). One study reported that LS-TBS may not be a better indicator of fracture in African Americans with T2D, as described for their Caucasian counterparts (5). Thus, it is important to understanding associations between T2D and LS-TBS for each ethnic or racial group separately. Specifically, data are lacking in the literature concerning associations of TBS with T2D in older Mexican Americans (MAs). To evaluate the utility of LS-TBS for assessing fracture risk in MAs with T2D, it is important to first determine if lower LS-TBS is associated with T2D in older MA men and women.

The Cameron County Hispanic Cohort (CCHC) is a two-stage randomly selected “Framingham-like” cohort of MAs on the US Mexico border with severe health disparities. Prevalence of T2D in this cohort is much higher than the national average 9, 10. Here, we report associations between LS-TBS and T2D in the older MAs who are CCHC participants.

Section snippets

Study Participants

A bone health protocol (approved by UTHealth Committee for the Protection of Human Subjects) was developed in 2013 to understand epidemiology of skeletal health risk factors in relation to age-related bone loss and fracture risk in this population. Under this protocol, participants receive annual DXA-acquired BMD of the hip and spine regions by Hologic QDR 4500 (Hologic Inc., Marlborough, MA). A total of 171 men and women (72 with T2D and 99 without diabetes) from the CCHC who were 50 years or

Results

Descriptive data for included subjects are shown in Table 1. Mean (±standard deviation) age for men and women were 64 (8) and 63 (8) yr. Mean (±standard deviation) BMI for men and women were 29 (4) and 30 (4) kg/m2. Men with T2D had a statistically significant higher mean LS-BMD than men without diabetes, but there was no difference in LS-BMD for women. Although there were no differences in TBS between men with T2D and without diabetes, women without diabetes had a significantly higher mean TBS

Discussion

It has been shown that fracture risk is higher in both men and women with T2D 11, 12 and that BMD assessment using DXA is paradoxically either normal or higher in subjects with diabetes. It has been proposed that LS-TBS may be a better indicator of fracture risk than BMD in T2D, but most studies investigating LS-TBS in individuals with have not included ethnicity as a variable. Here, we present an investigation of LS-BMD and LS-TBS in a population that has been understudied: older MA men and

Acknowledgments

We thank our cohort team, particularly, Neryeda Buenorostro and Rocio Uribe and their team, who recruited and documented the participants. We also thank Marcela Morris and other laboratory staff for their contributions, and Christina Villarreal for administrative support. We thank Valley Baptist Medical Center, Brownsville, Texas, for providing us space for our Center for Clinical and Translational Science Clinical Research Unit. We also thank the community of Brownsville, Laredo and Harlingen

References (15)

There are more references available in the full text version of this article.

Cited by (15)

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

    2022, Bone
    Citation Excerpt :

    The STT accounts for lean and fat content and is negatively related to TBS results due to its interference with DXA image quality [41]. Our work initially demonstrated that unadjusted TBS values were significantly lower in groups with the greatest HbA1c levels, in accordance with several studies that found lower unadjusted TBS values in women with T2D versus nondiabetic women [18,19,22,43,44]. Adjusting TBS values for covariates such as age, LS-BMD, and BMI did not change the results, similar to other authors that used the same correction approach when comparing TBS values in women with or without T2D [17,45].

  • Bibliometric analysis of publications on trabecular bone score (TBS)

    2023, Journal of Diabetes and Metabolic Disorders
  • Update on trabecular bone score

    2022, Archives of Endocrinology and Metabolism
View all citing articles on Scopus
View full text