Pancreatic fat infiltration is associated with risk of vertebral fracture in older patients with type 2 diabetes: A longitudinal multicenter study.

AIMS

Patients with type 2diabetesmellitus (T2DM) have high fracture risk. This study explored the associations between pancreatic computed tomography (CT) attenuation, a marker of pancreatic fat, and risk of vertebral fracture in T2DM patients.

METHODS

A total of 1486 T2DM patients who aged 50 years and older and without preexisting vertebral fractures during 2019-2023 at our institutions were followed up untilJanuary 2024. CT attenuation of the pancreas, bone and spleen were measured. Pancreatic attenuation/spleen attenuation ratio (P/S) was calculated. Vertebral fractures were evaluated on spine CT images according to Genant's semiquantitative scoring system.

RESULTS

A total of 135 cases of vertebral fracture were identified during 26 months of follow-up and 270 patients without vertebral fracture were matched. Pancreatic CT attenuation and the P/S ratio were negatively associated with the risk of vertebral fracture (adjusted hazard ratio (aHR) = 0.97, 95 %confidence interval (CI): 0.96-0.99; aHR = 0.26, 95 %CI: 0.12-0.58). Addition of pancreatic attenuation or P/S ratio improved the performance of bone attenuation-based model (area under the curve = 0.72-0.763 vs 0.63-0.728).

CONCLUSION

Pancreatic fat infiltration is an associated factor for vertebral fracture in T2DM patients. Addition of pancreatic fat infiltration improved the predictive performance of the bone-based model.