Abstract：
Individuals with type 2 diabetes have lower trabecular bone score (TBS) and increased fracture risk despite higher bone mineral density. However, measures of trabecular microarchitecture from high-resolution peripheral computed tomography are not lower in type 2 diabetes. We hypothesized that confounding effects of abdominal tissue thickness may explain this discrepancy, since central obesity is a risk factor for diabetes and also artifactually lowers TBS. This hypothesis was tested in individuals aged 40 years and older from a large DXA registry, stratified by sex and diabetes status. When DXA-measured abdominal tissue thickness was not included as a covariate, men without diabetes had lower TBS than women without diabetes (mean difference -0.074, P < .001). TBS was lower in women with versus without diabetes (mean difference -0.037, P < .001), and men with versus without diabetes (mean difference -0.007, P = .042). When adjusted for tissue thickness these findings reversed, TBS became greater in men versus women without diabetes (mean difference +0.053, P < .001), in women with versus without diabetes (mean difference +0.008, P < .001), and in men with versus without diabetes (mean difference +0.014, P < .001). During mean 8.7 years observation, incident major osteoporotic fractures were seen in 7048 (9.6%). Adjusted for multiple covariates except tissue thickness, TBS predicted fracture in all subgroups with no significant diabetes interaction. When further adjusted for tissue thickness, HR per SD lower TBS remained significant and even increased slightly. In conclusion, TBS predicts fractures independent of other clinical risk factors in both women and men, with and without diabetes. Excess abdominal tissue thickness in men and individuals with type 2 diabetes may artifactually lower TBS using the current algorithm, which reverses after accounting for tissue thickness. This supports ongoing efforts to update the TBS algorithm to directly account for the effects of abdominal tissue thickness for improved fracture risk prediction.
Individuals with type 2 diabetes are at increased fracture risk despite having higher bone mineral density (BMD). Previous studies suggest that trabecular bone score (TBS), a measure of bone derived from spine DXA images that can be used to assess fracture risk in addition to BMD, may be lower in individuals with type 2 diabetes. However, TBS is artificially lowered by greater abdominal obesity. We showed that abdominal obesity explained the lower TBS measurements that were seen in individuals with type 2 diabetes. However, even when we considered the effect of abdominal obesity, TBS was still able to predict major fractures in both women and men, with and without diabetes.
Individuals with type 2 diabetes are at increased fracture risk despite having higher bone mineral density (BMD). Previous studies suggest that trabecular bone score (TBS), a measure of bone derived from spine DXA images that can be used to assess fracture risk in addition to BMD, may be lower in individuals with type 2 diabetes. However, TBS is artificially lowered by greater abdominal obesity. We showed that abdominal obesity explained the lower TBS measurements that were seen in individuals with type 2 diabetes. However, even when we considered the effect of abdominal obesity, TBS was still able to predict major fractures in both women and men, with and without diabetes.
摘要：
2型糖尿病患者尽管骨矿物质密度（BMD）较高，但骨小梁骨评分（TBS）较低，骨折风险增加。然而,在2型糖尿病患者中,高分辨率外周计算机断层扫描(HRpQCT)的小梁微结构测量值并不低.我们假设腹部组织厚度的混杂效应可以解释这种差异，因为中心性肥胖是糖尿病的危险因素，并且还人为地降低了TBS。这一假设在40岁及以上的个体中进行了测试，来自大型DXA注册表，按性别和糖尿病状态分层。当DXA测量的腹部组织厚度不作为协变量时，无糖尿病男性的TBS低于无糖尿病女性(平均差异-0.074,p<0.001).与没有糖尿病的女性相比，TBS较低（平均差异-0.037，p<0.001），以及有糖尿病的男性与没有糖尿病的男性（平均差-0.007，p=0.042）。当调整组织厚度时，这些发现逆转了，和TBS变得更大的男性比女性没有糖尿病（平均差异0.053，p<0.001），有糖尿病的女性与没有糖尿病的女性(平均差+0.008,p<0.001)和有糖尿病的男性与没有糖尿病的男性(平均差+0.014,p<0.001)。在平均8.7年的观察中，7048例(9.6%)发生严重骨质疏松性骨折。除组织厚度外，针对多个协变量进行了调整，TBS可预测所有亚组的骨折，无明显的糖尿病交互作用。当进一步调整组织厚度时，HR每SD较低的TBS仍然显着，甚至略有增加。总之,TBS在女性和男性中预测骨折独立于其他临床危险因素，有和没有糖尿病。使用当前算法，男性和2型糖尿病患者的腹部组织厚度过多可能会降低TBS，在考虑组织厚度后反转。这支持正在进行的更新TBS算法的努力，以直接考虑腹部组织厚度的影响，以改善骨折风险预测。
患有2型糖尿病的个体尽管具有较高的骨矿物质密度(BMD),但骨折风险增加。以前的研究表明，骨小梁评分（TBS），来自脊柱DXA图像的骨测量，可用于评估除BMD外的骨折风险，在2型糖尿病患者中可能较低。然而,TBS是人为降低更大的腹部肥胖。我们表明，腹部肥胖解释了在2型糖尿病患者中观察到的较低的TBS测量值。然而,即使我们考虑到腹部肥胖的影响，TBS仍然能够预测女性和男性的严重骨折，有和没有糖尿病。
患有2型糖尿病的个体尽管具有较高的骨矿物质密度(BMD),但骨折风险增加。以前的研究表明，骨小梁评分（TBS），来自脊柱DXA图像的骨测量，可用于评估除BMD外的骨折风险，在2型糖尿病患者中可能较低。然而,TBS是人为降低更大的腹部肥胖。我们表明，腹部肥胖解释了在2型糖尿病患者中观察到的较低的TBS测量值。然而,即使我们考虑到腹部肥胖的影响，TBS仍然能够预测女性和男性的严重骨折，有和没有糖尿病。
