Fazullina Olga N, Korbut Anton I, Klimontov Vadim V
Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Novosibirsk 630060, Russia.
World J Diabetes. 2022 Jul 15;13(7):553-565. doi: 10.4239/wjd.v13.i7.553.
Osteoporosis and type 2 diabetes (T2D) have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden. In T2D, bone mineral density (BMD) may underestimate the risk of low-energy fractures as bone quality is reduced. It was hypothesized that a decrease in the trabecular bone score (TBS), a parameter assessing bone microarchitecture, may be an early marker of impaired bone health in women with T2D.
To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.
A non-interventional cross-sectional comparative study was conducted. Potentially eligible subjects were screened at tertiary referral center. Postmenopausal women with T2D, aged 50-75 years, with no established risk factors for secondary osteoporosis, were included. BMD, TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry. In women with normal BMD, a wide range of anthropometric, general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic (ROC) curves.
Three hundred twelve women were initially screened, 176 of them met the inclusion criteria and underwent dual X-ray absorptiometry. Those with reduced BMD were subsequently excluded; 96 women with normal BMD were included in final analysis. Among them, 43 women (44.8%) showed decreased TBS values (≤ 1.31). Women with TBS ≤ 1.31 were taller and had a lower body mass index (BMI) when compared to those with normal TBS ( = 0.008 and = 0.007 respectively). No significant differences in HbA1c, renal function, calcium, phosphorus, alkaline phosphatase, PTH and 25(ОН)D levels were found. In a model of multivariate linear regression analysis, TBS was positively associated with gynoid fat mass, whereas the height and androgen fat mass were associated negatively (all < 0.001). In a multiple logistic regression, TBS ≤ 1.31 was associated with lower gynoid fat mass (adjusted odd ratio [OR], 0.9, 95% confidence interval [CI], 0.85-0.94, < 0.001), higher android fat mass (adjusted OR, 1.13, 95%CI, 1.03-1.24, = 0.008) and height (adjusted OR, 1.13, 95%CI, 1.05-1.20, < 0.001). In ROC-curve analysis, height ≥ 162.5 cm ( = 0.04), body mass index ≤ 33.85 kg/m ( = 0.002), gynoid fat mass ≤ 5.41 kg ( = 0.03) and android/gynoid fat mass ratio ≥ 1.145 ( < 0.001) were identified as the risk factors for TBS reduction.
In postmenopausal women with T2D and normal BMD, greater height and central adiposity are associated with impaired bone microarchitecture.
骨质疏松症和2型糖尿病（T2D）已被认为是一种普遍存在的合并症，会导致额外的死亡率和巨大的医疗负担。在T2D中，由于骨质下降，骨矿物质密度（BMD）可能会低估低能量骨折的风险。据推测，小梁骨评分（TBS）的降低，即一种评估骨微结构的参数，可能是T2D女性骨健康受损的早期标志物。
确定影响绝经后T2D且BMD正常女性TBS的临床和身体成分参数。
进行了一项非干预性横断面比较研究。在三级转诊中心对潜在符合条件的受试者进行筛查。纳入年龄在50 - 75岁、无继发性骨质疏松既定危险因素的绝经后T2D女性。通过双能X线吸收法评估BMD、TBS和身体成分参数。对于BMD正常的女性，使用单变量和多变量回归分析以及受试者操作特征（ROC）曲线分析，评估一系列人体测量学、一般和糖尿病相关的临床及实验室参数作为TBS降低的危险因素。
最初筛查了312名女性，其中176名符合纳入标准并接受了双能X线吸收测定。随后排除了BMD降低的患者；96名BMD正常的女性纳入最终分析。其中，43名女性（44.8%）的TBS值降低（≤1.31）。与TBS正常的女性相比，TBS≤1.31的女性更高且体重指数（BMI）更低（分别为P = 0.008和P = 0.007）。未发现糖化血红蛋白、肾功能、钙、磷、碱性磷酸酶、甲状旁腺激素和25(OH)D水平存在显著差异。在多变量线性回归模型中，TBS与臀部脂肪量呈正相关，而身高和腹部脂肪量与之呈负相关（均P < 0.001）。在多因素逻辑回归中，TBS≤1.31与较低的臀部脂肪量（调整后的比值比[OR]，0.9，95%置信区间[CI]，0.85 - 0.94，P < 0.001）、较高的腹部脂肪量（调整后的OR，1.13，95%CI，1.03 - 1.24，P = 0.008）和身高（调整后的OR，1.13，95%CI，1.05 - 1.20，P < 0.001）相关。在ROC曲线分析中，身高≥162.5 cm（P = 0.04）、体重指数≤33.85 kg/m²（P = 0.002）、臀部脂肪量≤5.41 kg（P = 0.03）和腹部/臀部脂肪量比值≥1.145（P < 0.001）被确定为TBS降低的危险因素。
在绝经后T2D且BMD正常的女性中，较高的身高和中心性肥胖与骨微结构受损有关。
