Observational Study
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World J Diabetes. Jul 15, 2022; 13(7): 553-565
Published online Jul 15, 2022. doi: 10.4239/wjd.v13.i7.553
Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density
Olga N Fazullina, Anton I Korbut, Vadim V Klimontov
Olga N Fazullina, Anton I Korbut, Vadim V Klimontov, Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630060, Russia
Author contributions: Klimontov VV contributed to study conception and design, data analysis and interpretation; Fazullina ON and Korbut AI collected the data and performed data analysis and interpretation; Fazullina ON and Klimontov VV wrote the article; all authors approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the Ethical Committee of the RICEL - Branch of IC&G SB RAS (protocol N. 104 from 20 December 2014).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vadim V Klimontov, DSc, MD, PhD, Professor, Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Timakov Street 2, Novosibirsk 630060, Russia. klimontov@mail.ru
Received: February 15, 2022
Peer-review started: February 15, 2022
First decision: April 17, 2022
Revised: May 2, 2022
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: July 15, 2022
Abstract
BACKGROUND

Osteoporosis and type 2 diabetes (T2D) have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden. In T2D, bone mineral density (BMD) may underestimate the risk of low-energy fractures as bone quality is reduced. It was hypothesized that a decrease in the trabecular bone score (TBS), a parameter assessing bone microarchitecture, may be an early marker of impaired bone health in women with T2D.

AIM

To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.

METHODS

A non-interventional cross-sectional comparative study was conducted. Potentially eligible subjects were screened at tertiary referral center. Postmenopausal women with T2D, aged 50-75 years, with no established risk factors for secondary osteoporosis, were included. BMD, TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry. In women with normal BMD, a wide range of anthropometric, general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic (ROC) curves.

RESULTS

Three hundred twelve women were initially screened, 176 of them met the inclusion criteria and underwent dual X-ray absorptiometry. Those with reduced BMD were subsequently excluded; 96 women with normal BMD were included in final analysis. Among them, 43 women (44.8%) showed decreased TBS values (≤ 1.31). Women with TBS ≤ 1.31 were taller and had a lower body mass index (BMI) when compared to those with normal TBS (Р = 0.008 and P = 0.007 respectively). No significant differences in HbA1c, renal function, calcium, phosphorus, alkaline phosphatase, PTH and 25(ОН)D levels were found. In a model of multivariate linear regression analysis, TBS was positively associated with gynoid fat mass, whereas the height and androgen fat mass were associated negatively (all P < 0.001). In a multiple logistic regression, TBS ≤ 1.31 was associated with lower gynoid fat mass (adjusted odd ratio [OR], 0.9, 95% confidence interval [CI], 0.85-0.94, P < 0.001), higher android fat mass (adjusted OR, 1.13, 95%CI, 1.03-1.24, P = 0.008) and height (adjusted OR, 1.13, 95%CI, 1.05-1.20, P < 0.001). In ROC-curve analysis, height ≥ 162.5 cm (P = 0.04), body mass index ≤ 33.85 kg/m2 (P = 0.002), gynoid fat mass ≤ 5.41 kg (P = 0.03) and android/gynoid fat mass ratio ≥ 1.145 (P < 0.001) were identified as the risk factors for TBS reduction.

CONCLUSION

In postmenopausal women with T2D and normal BMD, greater height and central adiposity are associated with impaired bone microarchitecture.

Keywords: Diabetes, Osteoporosis, Bone mineral density, Trabecular bone score, Obesity, Body composition

Core Tip: In this study, we assessed the impact of a wide range of general and diabetes-related parameters on trabecular bone score (TBS) in postmenopausal women with type 2 diabetes (T2D) and normal bone mineral density (BMD). A decrease in TBS was revealed in 44.8% of study participants. These data indicate that a substantial proportion of postmenopausal women with T2D and normal BMD may have impaired bone microarchitecture. Greater height and central adiposity turned out to be the risk factors for decreased TBS in these women.