Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
Calcif Tissue Int. 2017 Oct;101(4):404-411. doi: 10.1007/s00223-017-0297-9. Epub 2017 Jun 29.
Literature data reported that in elderly subjects, carotid intima-media thickness (IMT) was negatively associated with bone mineral density (BMD). Paradoxically, type-2 diabetes (T2DM) patients, despite having higher BMD, present an increased risk of fragility fractures and cardiovascular complications. Some studies have reported trabecular bone score (TBS), an index of trabecular bone quality, as possibly being reduced in T2DM. This study aimed to evaluate whether in T2DM subjects TBS was better associated with IMT with respect to BMD. In 131 consecutive T2DM subjects (55 men and 76 women; mean age: 60.0 ± 7.3 years) and 265 consecutive non-T2DM subjects (107 men and 158 women; mean age: 58.9 ± 7.8 years) we measured carotid IMT by high-resolution ultrasonography and BMD at lumbar spine (LS-BMD), at femoral neck FN-BMD and total hip TH-BMD; TBS was calculated using TBS iNsight software. LS-BMD, FN-BMD, and TH-BMD were all significantly higher in T2DM than in non-T2DM subjects, whereas TBS was significantly lower in T2DM subjects than in controls and inversely correlated with diabetes duration. In T2DM subjects multiple regression analysis showed that IMT was positively associated with age (b = 0.017; p < 0.001) and inversely associated with TBS (b = -0.473; p = 0.038). In non-T2DM subjects, only age was positively associated with IMT. To sum up, T2DM subjects present higher values of BMD and lower values of TBS with respect to non-diabetic controls. Moreover, in T2DM subjects TBS was found to be independently associated with carotid IMT. These findings suggest that TBS may not only capture bone fragility-related factors, but also some information associated with greater risk of developing cardiovascular diseases.
文献数据表明，在老年人群中，颈动脉内膜中层厚度（IMT）与骨密度（BMD）呈负相关。矛盾的是，2 型糖尿病（T2DM）患者尽管 BMD 较高，但脆性骨折和心血管并发症的风险增加。一些研究报告称，T2DM 患者的小梁骨骨密度（TBS）可能降低，TBS 是小梁骨质量的一个指标。本研究旨在评估 T2DM 患者的 TBS 是否与 IMT 比 BMD 更相关。在 131 例连续的 T2DM 患者（55 名男性和 76 名女性；平均年龄：60.0±7.3 岁）和 265 例连续的非 T2DM 患者（107 名男性和 158 名女性；平均年龄：58.9±7.8 岁）中，我们使用高分辨率超声测量颈动脉 IMT，并测量腰椎（LS-BMD）、股骨颈（FN-BMD）和全髋（TH-BMD）的 BMD；使用 TBS iNsight 软件计算 TBS。T2DM 患者的 LS-BMD、FN-BMD 和 TH-BMD 均明显高于非 T2DM 患者，而 T2DM 患者的 TBS 明显低于对照组，并与糖尿病病程呈负相关。在 T2DM 患者中，多元回归分析显示，IMT 与年龄呈正相关（b=0.017；p<0.001），与 TBS 呈负相关（b=-0.473；p=0.038）。在非 T2DM 患者中，只有年龄与 IMT 呈正相关。总之，与非糖尿病对照组相比，T2DM 患者的 BMD 值较高，而 TBS 值较低。此外，在 T2DM 患者中，TBS 被发现与颈动脉 IMT 独立相关。这些发现表明，TBS 不仅可以捕捉与骨脆弱性相关的因素，还可以捕捉与心血管疾病风险增加相关的一些信息。
