Trabecular bone score worse in patients with type 2 diabetes despite good BMD

BALTIMORE — Trabecular bone score data presented at ASBMR 2013 showed that trabecular bone is affected in patients with type 2 diabetes even when their overall bone mineral density score is within normal ranges.

“We wanted to investigate why people with diabetes are more prone to have fractures despite the fact that their bone density is very good,” Mishaela R. Rubin, MD, assistant professor at Columbia University, told Endocrine Today. “We found that the trabecular bone score was worse in the patients with diabetes, even though their bone density was normal, which seems to suggest that perhaps there’s some defect in the trabecular bone that could be important and contribute to their fracture risk.”

In a study of 14 postmenopausal women with type 2 diabetes and 21 controls, the researchers extracted trabecular bone score (TBS) data from a DXA image and found that, after adjusting for weight, despite similar lumbar spine BMD in patients with diabetes and controls (0.920 g/cm2 vs. 0.938 g/cm2, respectively; P=.68), TBS was lower in patients with type 2 diabetes than controls (1.146 g/cm2 vs. 1.27 g/cm2, respectively; P=.01). 

Patients with type 2 diabetes also had lower 25-hydroxyvitamin D (18.2 ng/mL vs. 33.9 ng/mL in controls; P=.02) and P1NP (45.6 ng/mL vs. 63.2 ng/mL in controls; P=.06) levels, but higher bone alkaline phosphatase (50.6 U/L vs. 34.7 U/L in controls; P=.003).

The researchers are pursuing the hypothesis that the lower TBS score may be related to a defect in mineralization.

 “Patients with diabetes need to be aware of bone health issues,” Rubin said. “They are especially at an increased risk of having fractures despite the fact that their bone density is normal and need to be careful in terms of calcium and vitamin D supplements and fracture prevention.”

For more information:

Rubin MR. Poster MO0439. Presented at: the American Society for Bone and Mineral Research 2013 Annual Meeting; Oct. 4-7, 2013; Baltimore.

Disclosure: Rubin reports no relevant financial disclosures.

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