Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain.
Bone Metabolic Unit, Endocrinology and Nutrition Division. University Hospital Clínico San Cecilio. Av. de la Ilustración, s/n, 18016, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA). Av. Madrid 15, 18012, Granada, Spain; CIBERFES, Instituto de Salud Carlos III. C/ Sinesio Delgado, 4, 28029, Madrid, Spain.
Diabetes Metab. 2021 Nov;47(6):101276. doi: 10.1016/j.diabet.2021.101276. Epub 2021 Sep 10.
To examine the clinical and biochemical determinants of trabecular bone score (TBS) in type 2 diabetes mellitus (T2DM) patients.
Cross-sectional observational study in 137 T2DM patients (49-85 years). Whole-body fat percentage was estimated using the relative fat mass (RFM) equation. Bone mineral density (BMD) and TBS were assessed using dual-energy X-ray absorptiometry and TBS iNsight Software respectively.
T2DM patients showed significantly lower TBS values (P < 0.001) despite significantly higher lumbar spine BMD (LS-BMD) (P = 0.025) compared to controls. TBS values were negatively correlated with body mass index (BMI) (P < 0.001), waist circumference (P < 0.001), and HOMA-2IR index (P = 0.004) and positively correlated with sex hormone-binding globulin (SHBG) (P = 0.01) and LS-BMD (P = 0.003). RFM was negatively associated with TBS in both males (P < 0.001) and females (P = 0.005). The multivariate analysis showed that RFM, HOMA2-IR (negative), SHBG, and LS-BMD (positive) were the variables independently associated with TBS. ROC analysis revealed RFM as the variable with the highest predictive value for risk of degraded bone microarchitecture.
The adiposity estimated by RFM may negatively affect TBS and this relationship may be influenced by insulin resistance and SHBG. RFM could act as a key estimator of degraded bone microarchitecture risk in the T2DM population.
研究 2 型糖尿病（T2DM）患者的临床和生化指标与小梁骨评分（TBS）的关系。
这是一项横断面观察性研究，共纳入 137 例 T2DM 患者（年龄 49-85 岁）。采用相对脂肪质量（RFM）方程估计全身脂肪百分比。采用双能 X 射线吸收法和 TBS iNsight 软件分别评估骨密度（BMD）和 TBS。
与对照组相比，T2DM 患者的 TBS 值明显较低（P<0.001），但腰椎 BMD（LS-BMD）明显较高（P=0.025）。TBS 值与体重指数（BMI）（P<0.001）、腰围（P<0.001）和 HOMA-2IR 指数（P=0.004）呈负相关，与性激素结合球蛋白（SHBG）（P=0.01）和 LS-BMD（P=0.003）呈正相关。RFM 与男性（P<0.001）和女性（P=0.005）的 TBS 均呈负相关。多元分析显示，RFM、HOMA2-IR（负相关）、SHBG 和 LS-BMD（正相关）是与 TBS 独立相关的变量。ROC 分析显示，RFM 是预测骨微结构受损风险的最佳变量。
RFM 估计的肥胖程度可能会对 TBS 产生负面影响，这种关系可能受胰岛素抵抗和 SHBG 的影响。RFM 可作为 T2DM 患者骨微结构受损风险的关键评估指标。
