Effect of Abdominal Tissue Thickness on Trabecular Bone Score and Fracture Risk in Adults With Diabetes: The Manitoba BMD Registry.

Details

Serval ID
serval:BIB_B7CD6BD647BB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effect of Abdominal Tissue Thickness on Trabecular Bone Score and Fracture Risk in Adults With Diabetes: The Manitoba BMD Registry.
Journal
Journal of bone and mineral research
Author(s)
Leslie W.D., Binkley N., Schousboe J.T., Silva B.C., Hans D.
ISSN
1523-4681 (Electronic)
ISSN-L
0884-0431
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Individuals with type 2 diabetes have lower trabecular bone score (TBS) and increased fracture risk despite higher bone mineral density (BMD). However, measures of trabecular microarchitecture from high resolution peripheral computed tomography (HRpQCT) 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<0.001). TBS was lower in women with versus without diabetes (mean difference -0.037, p<0.001), and men with versus without diabetes (mean difference -0.007, p=0.042). When adjusted for tissue thickness these findings reversed, and TBS became greater in men versus women without diabetes (mean difference +0.053, p<0.001), in women with versus without diabetes (mean difference +0.008, p<0.001) and in men with versus without diabetes (mean difference +0.014, p<0.001). 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.
Keywords
Diabetes, Dual-energy x-ray absorptiometry, Fracture risk assessment, Osteoporosis, Trabecular bone score
Pubmed
Open Access
Yes
Create date
16/05/2024 15:31
Last modification date
17/05/2024 6:57
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