Published online Jul 15, 2022. doi: 10.4239/wjd.v13.i7.553
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
Processing time: 145 Days and 15.1 Hours
People with type 2 diabetes (T2D) have higher risk of vertebral and some non-vertebral fractures than non-diabetic individuals, regardless of normal or even increased bone mineral density (BMD). As BMD assessment may lead to underestimation of a fracture risk in T2D, additional parameters of bone health should be taken into consideration. The impaired bone microarchitecture is considered as a major contributor to fracture risk in T2D. Trabecular Bone Score (TBS) on lumbar spine dual X-ray absorptiometry (DXA) images is increasingly applied for the assessment of bone microarchitecture. Individuals with diabetes as compared to those without have significantly lower TBS.
At present, data on TBS in postmenopausal women with T2D and normal BMD is limited, and predictors of TBS decrease in these women need to be refined. In particular, the role of body composition and diabetes-related parameters as risk factors for deterioration of bone microarchitecture needs further research.
To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.
A non-interventional cross-sectional comparative study was conducted. 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 DXA. 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.
Among women with normal BMD, 44.8% showed decreased TBS values (≤ 1.31). Women with decreased TBS were taller and had a lower BMI when compared to those with normal TBS. No significant differences in HbA1c, renal function, calcium, phosphorus, alkaline phosphatase, PTH and 25(ОН)D levels were found. In the models of multivariate regression analysis, TBS was positively associated with gynoid fat mass, whereas the height and androgen fat mass were associated negatively. In the ROC-curve analysis, height ≥ 162.5 cm, body mass index < 33.85 kg/m2, gynoid fat mass ≤ 5.41 kg and android/gynoid fat mass ratio ≥ 1.145 were identified as the risk factors for TBS reduction.
The obtained results 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. The results give further support to notion that estimation of TBS should be an essential element of DXA protocol in postmenopausal women with T2D.
The prognostic value of TBS as a risk factor for fractures in patients with T2D and normal BMD needs further research. Prospective studies should determine the effect of changes in body weight and body composition on bone microarchitecture in these patients. The impact of hyperglycemia, glucose variability and metabolic memory, as well as various antihyperglycemic drugs, also needs to be clarified.