Original ArticleTrabecular Bone Score Is a Valuable Addition to Bone Mineral Density for Bone Quality Assessment in Older Mexican American Women With Type 2 Diabetes
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)
- et al.
Hyperglycemia is associated with increased bone mineral density and decreased trabecular bone score in elderly Japanese men: the Fujiwara-kyo osteoporosis risk in men (FORMEN) study
Bone
(2017) - et al.
DXA-based measurements in diabetes: can they predict fracture risk?
Calcif Tissue Int
(2017) - et al.
Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes
JAMA
(2011) - et al.
The impact of diabetes and diabetes medications on bone health
Endocr Rev
(2015) - et al.
Trabecular bone score: a noninvasive analytical method based on upon the DXA image
J Bone Miner Res
(2014) - et al.
African Americans have lower TBS than whites among densitometry patients at a Chicago academic center
Osteoporos Int
(2017) - et al.
TBS (trabecular bone score) and diabetes-related fracture risk
J Clin Endocrinol Metab
(2013)
Cited by (15)
Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study
2022, BoneCitation 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].
Diagnostic Value of Trabecular Bone Score in Osteoporosis
2023, Iranian Journal of RadiologyBibliometric analysis of publications on trabecular bone score (TBS)
2023, Journal of Diabetes and Metabolic DisordersUpdate on trabecular bone score
2022, Archives of Endocrinology and MetabolismA comparison between femoral neck and LS-BMD with LS-TBS in T2DM patients: a case control study
2021, BMC Musculoskeletal Disorders