Abstract
Diabetes is associated with increased skeletal fragility, despite higher bone mineral density (BMD). Alternative measures are necessary to more accurately determine fracture risk in individuals with diabetes. Therefore, we aimed to describe the relationship between trabecular bone score (TBS) and normoglycaemia, impaired fasting glucose (IFG) and diabetes and determine whether TBS-adjusted FRAX (Aus) score differed between these groups. This study included 555 men (68.7 ± 12.2 years) and 514 women (62.0 ± 12.0 years), enrolled in the observational Geelong Osteoporosis Study. IFG was considered as fasting plasma glucose (FPG) ≥ 5.5 mmol/L and diabetes as FPG ≥ 7.0 mmol/L, with the use of antihyperglycaemic medication and/or self-report. Using multivariable regression, the relationship between groups and TBS was determined. Men and women (all ages) with diabetes had lower mean TBS compared to those with normoglycaemia, in models adjusted for age, height and weight/waist circumference (all p < 0.05). Men with IFG had lower mean TBS in the age-adjusted models only (all p < 0.05). The addition of TBS to the FRAX score improved the discrimination between glycaemia groups, particularly for younger women (< 65 years). There was no difference in TBS detected between normoglycaemia and IFG; however, those with diabetes had lower TBS. Thus, the increased fracture risk in men and women with diabetes may be a result of BMD-independent bone deterioration. TBS adjustment of FRAX scores may be useful for younger women (< 65 years) with diabetes. This suggests that halting or reversing progression from IFG to diabetes could be important to prevent skeletal fragility in diabetes.
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Acknowledgements
Study was supported by the National Health and Medical Research Council (NHMRC) of Australia (251638, 299831, 628582), the Geelong Regional Medical Foundation, Arthritis Foundation of Australia and Perpetual Trustees. NKH is supported by an Australian Postgraduate Award. KLH is supported by an Alfred Deakin Postdoctoral Research Fellowship. LLFA and MAS are supported by Deakin Postgraduate Scholarships.
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KLH, MAK and JAP conceived the original plan for the study. DH provided TBS data for the study. KLH and JAP carried out the statistical analysis. KLH, MAK, DH and JAP interpreted the results. KLH wrote the original draft of the manuscript and all other authors provided expertise and advice to produce the final version of the manuscript.
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Kara L. Holloway, Lelia L. F. De Abreu, Didier Hans, Mark A. Kotowicz, Muhammad A. Sajjad, Natalie K. Hyde, and Julie A. Pasco have no conflicts of interest to declare.
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The study was approved by the Barwon Health Human Research Ethics Committee, and written informed consent was obtained from all participants.
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Holloway, K.L., De Abreu, L.L.F., Hans, D. et al. Trabecular Bone Score in Men and Women with Impaired Fasting Glucose and Diabetes. Calcif Tissue Int 102, 32–40 (2018). https://doi.org/10.1007/s00223-017-0330-z
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DOI: https://doi.org/10.1007/s00223-017-0330-z