Deakin University, Geelong, Australia.
Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland.
Calcif Tissue Int. 2018 Jan;102(1):32-40. doi: 10.1007/s00223-017-0330-z. Epub 2017 Sep 30.
Diabetes is associated with increased skeletal fragility, despite higher bone mineral density (BMD). Alternative measures are necessary to more accurately determine fracture risk in individuals with diabetes. Therefore, we aimed to describe the relationship between trabecular bone score (TBS) and normoglycaemia, impaired fasting glucose (IFG) and diabetes and determine whether TBS-adjusted FRAX (Aus) score differed between these groups. This study included 555 men (68.7 ± 12.2 years) and 514 women (62.0 ± 12.0 years), enrolled in the observational Geelong Osteoporosis Study. IFG was considered as fasting plasma glucose (FPG) ≥ 5.5 mmol/L and diabetes as FPG ≥ 7.0 mmol/L, with the use of antihyperglycaemic medication and/or self-report. Using multivariable regression, the relationship between groups and TBS was determined. Men and women (all ages) with diabetes had lower mean TBS compared to those with normoglycaemia, in models adjusted for age, height and weight/waist circumference (all p < 0.05). Men with IFG had lower mean TBS in the age-adjusted models only (all p < 0.05). The addition of TBS to the FRAX score improved the discrimination between glycaemia groups, particularly for younger women (< 65 years). There was no difference in TBS detected between normoglycaemia and IFG; however, those with diabetes had lower TBS. Thus, the increased fracture risk in men and women with diabetes may be a result of BMD-independent bone deterioration. TBS adjustment of FRAX scores may be useful for younger women (< 65 years) with diabetes. This suggests that halting or reversing progression from IFG to diabetes could be important to prevent skeletal fragility in diabetes.
糖尿病与骨脆性增加有关，尽管骨密度（BMD）较高。需要替代措施来更准确地确定糖尿病患者的骨折风险。因此，我们旨在描述骨小梁评分（TBS）与正常血糖、空腹血糖受损（IFG）和糖尿病之间的关系，并确定这些组之间 TBS 调整后的 FRAX（澳大利亚）评分是否存在差异。本研究纳入了 555 名男性（68.7±12.2 岁）和 514 名女性（62.0±12.0 岁），他们参加了观察性的 Geelong 骨质疏松症研究。IFG 被定义为空腹血糖（FPG）≥5.5mmol/L，糖尿病为 FPG≥7.0mmol/L，同时使用降血糖药物和/或自我报告。使用多变量回归确定了组与 TBS 之间的关系。在调整年龄、身高和体重/腰围（均 P<0.05）后，与正常血糖相比，所有年龄的男性和女性糖尿病患者的平均 TBS 较低。仅在年龄调整模型中，IFG 男性的平均 TBS 较低（均 P<0.05）。将 TBS 添加到 FRAX 评分中可改善血糖组之间的区分度，尤其是对于年龄较小的女性（<65 岁）。在正常血糖和 IFG 之间未检测到 TBS 差异；然而，糖尿病患者的 TBS 较低。因此，糖尿病男性和女性骨折风险增加可能是 BMD 独立的骨恶化的结果。TBS 调整的 FRAX 评分可能对年龄较小的女性（<65 岁）有帮助。这表明阻止或逆转 IFG 向糖尿病的进展对于预防糖尿病患者的骨骼脆弱性可能很重要。
