Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus
Autoři:
Masahiro Yamamoto aff001; Mika Yamauchi aff001; Toshitsugu Sugimoto aff001
Působiště autorů:
Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
aff001
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222571
Souhrn
Background
An assessment of bone strength based on bone mineral density (BMD) underestimates the risk of fracture in patients with diabetes mellitus (T2DM). However, using the trabecular bone score (TBS) for estimating bone microarchitecture, previous studies showed that bone fragility is associated with deterioration of the microstructure concomitantly with decreased BMD. This study was conducted to clarify which of these skeletal-related factors had a more prominent relationship with bone fragility.
Research design and methods
A retrospective cross-sectional study was performed at Shimane University Hospital. A total of 548 Japanese patients with T2DM [257 postmenopausal women and 291 men aged over 50 years] were included. TBS of the spine was computed from dual-energy X-ray absorptiometry images obtained from BMD measurements.
Results
Vertebral fractures (VFs) were identified in 74 (28.8%) women and 115 (39.5%) men. A relationship between BMD and VFs was observed in the limited subgroup of women with a BMD T-score ≤-1.0. According to multivariate logistic regression analysis, low TBS was significantly correlated with prevalent VFs, independent of BMD in both genders, except for men with a BMD T-score > -1.0. The decision tree showed that the priority factor for determining VFs was TBS, not BMD.
Conclusion
Spinal microarchitecture represented by TBS was a more dominant skeletal factor for bone fragility than the decrease in bone mass, independent of BMD, in patients with T2DM. This observation suggests that loss of structural bone quality was crucial underlying pathogenesis for bone brittleness in these populations, regardless of gender. An integrated assessment of bone strength by BMD and TBS would help diagnose diabetic osteoporosis.
Klíčová slova:
Medicine and health sciences – Critical care and emergency medicine – Trauma medicine – Traumatic injury – Bone fracture – Endocrinology – Endocrine disorders – Metabolic disorders – Bone – Rheumatology – Connective tissue diseases – Osteoporosis – Engineering and technology – Management engineering – Research and analysis methods – Decision analysis – Decision trees – Biology and life sciences – Anatomy – Biological tissue – Connective tissue – Musculoskeletal system – Spine – Physical sciences – Chemistry – Chemical compounds – Phosphates
Zdroje
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Článek vyšel v časopise
PLOS One
2019 Číslo 9
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