Department of Endocrinology, Changi General Hospital, Singapore, Singapore.
Department of Radiology, Changi General Hospital, Singapore, Singapore.
PLoS One. 2020 Nov 19;15(11):e0241616. doi: 10.1371/journal.pone.0241616. eCollection 2020.
Studies show trabecular bone score (TBS) may provide information regarding bone quality independent of bone mineral density (BMD) in type 2 diabetes (DM2) patients. We analyzed our Southeast Asian severe osteoporotic hip fracture patients to study these differences.
We conducted a retrospective cross-sectional analysis of subjects admitted to Changi General Hospital, Singapore with severe osteoporotic hip fractures from 2014-2017 who had BMD performed. Electronic records were reviewed and subjects were classified as having diabetes according to the WHO 2019 criteria. DM2 patients were classified according to their HbA1c into well controlled (HbA1c < 7%) and poorly controlled (HbA1c ≥ 7%) DM2.
Elderly patients with hip fractures present with average femur neck T scores at the osteoporotic range, however those with DM2 had higher BMD and TBS values compared to non DM2 patients. These differences were statistically significant in elderly women-poorly controlled elderly DM2 women with hip fracture had the highest total hip T-score (-2.57 ± 0.86) vs (-2.76 ± 0.96) in well controlled DM2 and (-3.09 ± 1.01) in non DM2 women with hip fracture, p < 0.001. In contrast, TBS scores were lower in poorly controlled DM2 women with hip fracture compared to well controlled DM2 women with hip fracture (1.22 ± 0.11) vs (1.24 ± 0.09), but these were still significantly higher compared to non DM2 women with hip fracture (1.19 ± 0.10), p < 0.001. In elderly men with hip fractures, univariate analysis showed no statistically significant differences in TBS or hip or LS BMD between those with poorly controlled DM2, well controlled DM2 and non DM2. The differences in TBS and BMD remained significant in all DM2 women with hip fractures even after adjustments for potential confounders. Differences in TBS and BMD in poorly controlled DM2 men with hip fractures only became significant after accounting for potential confounders. However, upon inclusion of LS BMD into the multivariate model these differences were attenuated and remained significant only between elderly women with well controlled DM2 and non DM2 women with hip fractures.
Elderly patients with DM2 and severe osteoporosis present with hip fractures at a higher BMD and TBS values compared to non DM2 patients. These differences were significant after adjustment for confounders in all DM2 women and poorly controlled DM2 men with hip fractures, TBS differences were attenuated with the inclusion LS BMD. Further studies are needed to ascertain differences in BMD and TBS in older Southeast Asian DM2 patients with variable glycemic control and severe osteoporosis.
研究表明，在 2 型糖尿病（DM2）患者中，小梁骨评分（TBS）可能提供独立于骨密度（BMD）的骨质量信息。我们分析了我们的东南亚严重骨质疏松性髋部骨折患者，以研究这些差异。
我们对 2014 年至 2017 年因严重骨质疏松性髋部骨折在新加坡樟宜综合医院住院的患者进行了回顾性横断面分析，这些患者均进行了 BMD 检查。查阅电子病历，根据世界卫生组织 2019 年标准将患者分类为糖尿病。根据 HbA1c 将 DM2 患者分为血糖控制良好（HbA1c<7%）和血糖控制不佳（HbA1c≥7%）的 DM2 患者。
髋部骨折的老年患者股骨颈 T 评分平均处于骨质疏松范围，但与非 DM2 患者相比，DM2 患者的 BMD 和 TBS 值更高。这些差异在老年女性中具有统计学意义——血糖控制不佳的老年 DM2 女性髋部骨折患者的总髋部 T 评分最高（-2.57±0.86），低于血糖控制良好的 DM2 患者（-2.76±0.96）和非 DM2 女性髋部骨折患者（-3.09±1.01），p<0.001。相比之下，血糖控制不佳的 DM2 女性髋部骨折患者的 TBS 评分低于血糖控制良好的 DM2 女性髋部骨折患者（1.22±0.11），但仍明显高于非 DM2 女性髋部骨折患者（1.19±0.10），p<0.001。在髋部骨折的老年男性中，单因素分析显示，血糖控制不佳的 DM2、血糖控制良好的 DM2 和非 DM2 患者的 TBS 或髋部或 LS BMD 之间无统计学显著差异。即使在调整了潜在混杂因素后，所有 DM2 女性髋部骨折患者的 TBS 和 BMD 差异仍然显著。只有在考虑潜在混杂因素后，血糖控制不佳的 DM2 男性髋部骨折患者的 TBS 和 BMD 差异才变得显著。然而，将 LS BMD 纳入多变量模型后，这些差异减弱，仅在血糖控制良好的 DM2 老年女性和非 DM2 老年女性髋部骨折患者之间具有统计学意义。
与非 DM2 患者相比，患有 2 型糖尿病和严重骨质疏松症的老年患者髋部骨折的 BMD 和 TBS 值更高。在所有 DM2 女性和血糖控制不佳的 DM2 男性髋部骨折患者中，调整混杂因素后，这些差异具有统计学意义，血糖控制不佳的 DM2 男性髋部骨折患者的 TBS 差异在纳入 LS BMD 后减弱。需要进一步研究以确定不同血糖控制水平和严重骨质疏松症的东南亚老年 2 型糖尿病患者的 BMD 和 TBS 差异。
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