Ferrari S, Akesson K E, Al-Daghri N, Biver E, Chandran M, Chevalley T, Josse R G, Kendler D L, Lane N E, Makras P, Meier C, Mithal Ambrish, Suzuki A, Vasikaran S, Pierroz D D, Leslie W D
Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Orthopedics, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Osteoporos Int. 2025 May 12. doi: 10.1007/s00198-025-07495-0.
Diabetes is associated with an increased risk of fracture. Areal bone mineral density (aBMD), the most reliable indicator of fracture risk in healthy adults, is low in patients with type 1 diabetes mellitus but normal or high in patients with type 2 diabetes mellitus. Most trabecular and cortical parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are lower in type 1 diabetes and higher in type 2 diabetes, in parallel with aBMD. In contrast, lumbar spine trabecular bone score (TBS) has been reported to be lower in women with both type 1 and type 2 diabetes. The discordance between improved bone microstructure and degraded TBS reflects the effect of central obesity (currently the subject of a revision to the TBS algorithm). Meanwhile, evidence supports use of TBS in conjunction with aBMD and/or FRAX for improved fracture prediction in patients with type T2D. This position paper, on behalf of the Bone and Diabetes Working Group of the International Osteoporosis Foundation, summarizes alterations in bone microarchitecture measured by HR-pQCT in diabetes. It also addresses the technical and clinical considerations of the trabecular bone score, particularly discussing the significance of this measurement in individuals with diabetes and the influence of abdominal fat.
糖尿病与骨折风险增加相关。面积骨密度（aBMD）是健康成年人骨折风险最可靠的指标，1型糖尿病患者的aBMD较低，而2型糖尿病患者的aBMD正常或较高。通过高分辨率外周定量计算机断层扫描（HR-pQCT）测量的大多数小梁和皮质参数在1型糖尿病中较低，在2型糖尿病中较高，与aBMD情况一致。相比之下，据报道1型和2型糖尿病女性的腰椎小梁骨评分（TBS）均较低。骨微结构改善与TBS降低之间的不一致反映了中心性肥胖的影响（目前TBS算法正在修订）。同时，有证据支持将TBS与aBMD和/或FRAX联合使用，以改善2型糖尿病患者的骨折预测。本立场文件代表国际骨质疏松基金会骨与糖尿病工作组，总结了糖尿病患者通过HR-pQCT测量的骨微结构变化。它还讨论了小梁骨评分的技术和临床考量，特别探讨了该测量在糖尿病个体中的意义以及腹部脂肪的影响。
