PDF(Pubmed)
Abstract：
Bone fragility is a complication of type 2 diabetes mellitus (T2DM) that has been identified in recent decades. Trabecular bone score (TBS) appears to be more accurate than bone mineral density (BMD) in diabetic bone disease, particularly in menopausal women with T2DM, to independently capture the fracture risk. Our purpose was to provide the most recent overview on TBS-associated clinical data in T2DM. The core of this narrative review is based on original studies (PubMed-indexed journals, full-length, English articles). The sample-based analysis (n = 11, N = 4653) confirmed the use of TBS in T2DM particularly in females (females/males ratio of 1.9), with ages varying between 35 and 91 (mean 65.34) years. With concern to the study design, apart from the transversal studies, two others were prospective, while another two were case-control. These early-post-pandemic data included studies of various sample sizes, such as: males and females (N of 245, 361, 511, and 2294), only women (N of 80, 96, 104, 243, 493, and 887), and only men (N = 169). Overall, this 21-month study on published data confirmed the prior profile of BMD-TBS in T2DM, while the issue of whether checking the fracture risk is mandatory in adults with uncontrolled T2DM remains to be proven or whether, on the other hand, a reduced TBS might function as a surrogate marker of complicated/uncontrolled T2DM. The interventional approach with bisphosphonates for treating T2DM-associated osteoporosis remains a standard one (n = 2). One control study on 4 mg zoledronic acid showed after 1 year a statistically significant increase of lumbar BMD in both diabetic and non-diabetic groups (+3.6%, p = 0.01 and +6.2%, p = 0.01, respectively). Further studies will pinpoint additive benefits on glucose status of anti-osteoporotic drugs or will confirm if certain glucose-lowering regimes are supplementarily beneficial for fracture risk reduction. The novelty of this literature research: these insights showed once again that the patients with T2DM often have a lower TBS than those without diabetes or with normal glucose levels. Therefore, the decline in TBS may reflect an early stage of bone health impairment in T2DM. The novelty of the TBS as a handy, non-invasive method that proved to be an index of bone microarchitecture confirms its practicality as an easily applicable tool for assessing bone fragility in T2DM.
摘要：
骨脆性是近几十年来发现的2型糖尿病（T2DM）的并发症。骨小梁评分（TBS）在糖尿病骨病中似乎比骨矿物质密度（BMD）更准确，特别是在患有T2DM的更年期女性中，独立捕捉骨折风险。我们的目的是提供有关T2DM中TBS相关临床数据的最新概述。这篇叙事评论的核心是基于原创研究(PubMed索引期刊，全长,英语文章）。基于样本的分析（n=11，N=4653）证实了TBS在T2DM中的使用，尤其是在女性中（女性/男性比为1.9），年龄在35至91岁之间（平均65.34岁）。考虑到研究设计，除了横向研究，另外两个是潜在的，而另外两个是病例控制。这些大流行后的早期数据包括各种样本量的研究，例如：男性和女性（N为245、361、511和2294），仅限女性（N为80、96、104、243、493和887），只有男性（N=169）。总的来说,这项针对已发表数据的21个月研究证实了T2DM中BMD-TBS的先前概况，虽然在患有不受控制的T2DM的成年人中检查骨折风险是否是强制性的问题仍有待证实，另一方面,减少的TBS可能是复杂/不受控制的T2DM的替代标志物。使用双膦酸盐治疗T2DM相关骨质疏松症的介入方法仍然是标准方法（n=2）。一项关于4mg唑来膦酸的对照研究显示，1年后，糖尿病和非糖尿病组的腰椎BMD显着增加（3.6％，p=0.01和+6.2%，分别为p=0.01)。进一步的研究将确定抗骨质疏松药物对葡萄糖状态的附加益处，或者将确认某些降糖方案是否对减少骨折风险具有补充益处。本文献研究的新颖性：这些见解再次表明，T2DM患者的TBS通常比没有糖尿病或血糖水平正常的患者低。因此,TBS的下降可能反映了T2DM患者骨健康损害的早期阶段.TBS的新颖性，被证明是骨微结构指标的非侵入性方法证实了其作为评估T2DM骨脆性的简单工具的实用性。
