Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

Table 1 Clinical characteristics of postmenopausal women with type 2 diabetes depending on trabecular bone score values

Parameter	Women with TBS > 1.31 (n = 53)	Women with TBS ≤ 1.31 (n = 43)	P value
Age (yr)	62 (59; 68)	65 (59; 72)	0.09
Age at menopause (yr)	50 (46; 53)	50 (45; 52.5)	0.6
Time since menopause (yr)	14 (10; 19)	17 (9; 21.5)	0.72
Diabetes duration (yr)	14 (10; 20)	19 (12; 23)	0.052
Height (cm)	160 (156; 165)	164 (160; 167)	0.008
Body weight (kg)	90 (81; 101)	84 (80; 93)	0.2
BMI (kg/m2)	35.3 (32.5; 37.2)	32 (29.7; 34.9)	0.007
WHR	0.95 (0.93; 1.0)	1.02 (0.9; 1.05)	0.37
HbA1c (%)	8.5 (7.1; 9.3)	8.9 (7.7; 10.1)	0.13
Total cholesterol (mmol/L)	4.4 (4.1; 5.6)	5.1 (3.9; 5.7)	0.44
LDL-cholesterol (mmol/L)	2.9 (2.6; 3.7)	3.4 (2.7; 3.9)	0.21
HDL-cholesterol (mmol/L)	1.3 (1.1; 1.5)	1.2 (1.1; 1.5)	0.67
Triglycerides (mmol/L)	1.8 (1.1; 2.5)	2.1 (1.4; 2.7)	0.31
hsCRP (mmol/L)	3.1 (1.8; 8.3)	3.3 (1.5; 7.3)	0.71
Calcium (mmol/L)	2.4 (2.4; 2.5)	2.4 (2.4; 2.5)	0.96
Phosphorus (mmol/L)	1.2 (1.1; 1.4)	1.3 (1.2; 1.4)	0.11
Alkaline phosphatase (IU/L)	84.6 (67.3; 107.3)	81.1 (64.8; 98.5)	0.66
PTH (pg/mL)	32.4 (24; 45.4)	31.2 (15.3; 39.0)	0.36
25(OH)D (ng/mL)	21.3 (15.8; 26.5)	18.7 (12.4; 24.2)	0.07
eGFR (mL/min/1.73 m2)	76 (55; 93)	72 (57; 92)	0.7
UACR (mg/mmoL)	0.6 (0.3; 1.1)	0.5 (0.3; 1.0)	0.18
Diabetic retinopathy, n (%)	24 (45.3%)	24 (55.8%)	0.38
CKD, n (%)	22 (41.5%)	20 (46.5%)	0.89
Diabetic neuropathy, n (%)	53 (100%)	43 (100%)	0.76
Peripheral artery disease, n (%)	19 (35.8%)	19 (48.3%)	0.42
Coronary artery disease, n (%)	17 (32.1%)	11 (27.6%)	0.59
Metformin, n (%)	43 (81.1%)	37 (86%)	0.68
Sulfonylurea, n (%)	20 (37.7%)	14 (32.6%)	0.67
DPP4 inhibitor, n (%)	3 (5.7%)	6 (14%)	0.49
SGLT2 inhibitor, n (%)	16 (30.2%)	10 (23.3%)	0.56
Insulin, n (%)	38 (71.7%)	32 (74.4%)	0.82
Fracture in medical history, n (%)	6 (11.3%)	14 (32.6%)	0.02
Low-energy fracture in medical history, n (%)	2 (3.8%)	9 (20.9%)	0.01

Data are presented as medians (25; 75 percentiles). TBS: Trabecular bone score; BMI: Body mass index; WHR: Waist-to-hip ratio; HbA1c: Hemoglobin A1c; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; hsCRP: High-sensitivity C-reactive protein; PTH: Parathyroid hormone; 25(ОН)D: 25-hydroxyvitamin D; eGFR: Estimated glomerular filtration rate; UACR: Urinary albumin-to-creatitine ratio; CKD: Chronic kidney disease; DPP4: Dipeptidyl peptidase-4; SGLT2: Sodium glucose cotransporter 2.

Table 2 Dual X-ray absorptiometry parameters and Fracture Risk Assessment tool scores in postmenopausal women with type 2 diabetes depending on trabecular bone score values

Parameter	Women with TBS > 1.31 (n = 53)	Women with TBS ≤ 1.31 (n = 43)	P value
TBS	1.465 (1.39; 1.514)	1.206 (1.127; 1.271)	< 0.001
T-score, minimal	0.0 (-0.5; 0.5)	-0.2 (-0.6; 0.3)	0.42
T-score, L1-L4	0.9 (0.1; 1.7)	1.0 (0.1; 1.7)	0.84
T-score, femoral neck	0.1 (-0.2; 0.7)	-0.05 (-0.5; 0.5)	0.42
T-score, total femur	1.3 (0.85; 1.6)	1.3 (0.6; 1.8)	0.97
T-score, radius	0.3 (-0.3; 0.7)	-0.05 (-0.7; 0.7)	0.27
BMD, L1-L4 (g/cm2)	1.278 (1.197; 1.387)	1.317 (1.205; 1.39)	0.86
BMD, neck (g/cm2)	1.044 (1.011; 1.129)	1.045 (0.968; 1.105)	0.45
BMD, total femur (g/cm2)	1.173 (1.099; 1.210)	1.178 (1.088; 1.237)	0.85
BMD, radius, (g/cm2)	0.897 (0.849; 0.939)	0.873 (0.816; 0.938)	0.27
FRAX major (%)	6.1 (5.7; 6.8)	6.4 (5.7; 7.1)	0.38
FRAX hip (%)	0.1 (0.1; 0.3)	0.3 (0.1; 0.4)	0.08
FRAX major, TBS-adjusted (%)	5.1 (4.6; 6.0)	7.8 (6.9; 9.2)	< 0.001
FRAX hip, TBS-adjusted (%)	0.1 (0.0; 0.2)	0.4 (0.2; 0.6)	< 0.001

Data are presented as medians (25; 75 percentiles). TBS: Trabecular bone score; BMD: Bone mineral density; FRAX: The Fracture Risk Assessment Tool; FRAX hip: 10-year risk of hip low-energy fractures; FRAX major: 10-year risk of major low-energy fractures.

Table 3 Body composition parameters in postmenopausal women with type 2 diabetes depending on trabecular bone score values

Parameter	Women with TBS > 1.31 (n = 53)	Women with TBS ≤ 1.31 (n = 43)	P value
Total fat mass (%)	45.1 (41.7; 48.3)	43.7 (40.2; 46.2)	0.1
Total fat mass (kg)	40.4 (33.0; 40.4)	36.8 (32.4; 39.5)	0.12
Trunk fat mass (kg)	23.0 (18.8; 25.9)	21.9 (20.2; 25.1)	0.89
Android fat mass (kg)	4.0 (2.9; 4.6)	3.9 (3.5; 4.7)	0.47
Gynoid fat mass (kg)	5.8 (4.9; 6.9)	4.9 (4.3; 5.9)	0.004
Android/gynoid fat mass ratio	1.07 (0.99; 1.17)	1.18 (1.12; 1.29)	< 0.001
Lean mass (kg)	48.2 (44.4; 52.0)	47.7 (44.0; 52.1)	0.83
Bone mineral component (kg)	2.5 (2.4; 2.6)	2.5 (2.3; 2.7)	0.8

Data are presented as medians (25; 75 percentiles). TBS: trabecular bone score.

Table 4 Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes

Parameter	Coefficient β ± SE	P value
Height (cm)	-0.008 ± 0.002	< 0.001
Android fat (100 g)	-0.007 ± 0.002	< 0.001
Gynoid fat (100 g)	0.007 ± 0.002	< 0.001

The linear regression models with backward stepwise selection. Parameters of the model: Intercept 2.54 ± 0.39, adjusted R2 0.31, SE of estimate 0.14, P value < 0.001.

Table 5 Factors associated with decreased trabecular bone score in postmenopausal women with type 2 diabetes

Parameter	Crude OR, 95%CI, P value	Adjusted OR, 95%CI, P value
Height, cm	1.10 (1.02-1.19), P = 0.01	1.13 (1.03-1.24), P = 0.008
Android fat, 100 g	1.02 (0.98-1.05), P = 0.38	1.13 (1.05-1.20), P < 0.001
Gynoid fat, 100 g	0.96 (0.93-0.99), P = 0.01	0.90 (0.85-0.94), P < 0.001

The logistic regression models with forward stepwise selection. Parameters of the model: Intercept 19.0, Kolmogorov–Smirnov test P value < 0.001, area under the curve 0.82, Selectivity 0.74, Specificity 0.77, OR 7.69, 95%CI (3.08-19.2), P < 0.001 for cut-off value of logistic function = 0.47. 95%CI: 95% confidence interval; OR: Odd ratio.

Table 6 Risk factors of decreased trabecular bone score in postmenopausal women with type 2 diabetes estimated by receiver operating characteristic-analysis

Parameter	Cut-off points	Se	Sp	AUC ± SE (95%CI), P value	OR (95%CI), P value
Height (cm)	≥ 162.5	0.605	0.604	0.66 ± 0.06 (0.55-0.77), P = 0.009	2.33 (1.02-5.31), P = 0.04
BMI (kg/m2)	≤ 33.85	0.70	0.62	0.66 ± 0.06 (0.55-0.77), P = 0.008	3.81 (1.62-8.96), P = 0.002
Gynoid fat (kg)	≤ 5.41	0.63	0.60	0.67 ± 0.06 (0.56-0.78), P = 0.004	2.49 (1.09-5.71), P = 0.03
Android fat mass (kg)	≥ 3.95	0.49	0.48	0.54 ± 0.06 (0.43-0.66), P = 0.46	0.88 (0.39-1.98), P = 0.76
Android/gynoid fat	≥ 1.145	0.70	0.71	0.75 ± 0.05 (0.66-0.85), P < 0.001	5.69 (2.35-13.79), P < 0.001

Sp: Specificity; Se: Sensitivity; AUC: Area under the curve; SE: Standard error; OR: Odd ratio; 95%CI: 95% Confidence interval; BMI: Body mass index.