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Trabecular bone score in type 1 diabetes—a cross-sectional study

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Abstract

Summary

Trabecular bone score (TBS) seems to provide additive value on BMD to identify individuals with prevalent fractures in T1D. TBS did not significantly differ between T1D patients and healthy controls, but TBS and HbA1c were independently associated with prevalent fractures in T1D. A TBS cutoff <1.42 reflected prevalent fractures with 91.7 % sensitivity and 43.2 % specificity.

Introduction

Type 1 diabetes (T1D) increases the risk of osteoporotic fractures. TBS was recently proposed as an indirect measure of bone microarchitecture. This study aimed at investigating the TBS in T1D patients and healthy controls. Associations with prevalent fractures were tested.

Methods

One hundred nineteen T1D patients (59 males, 60 premenopausal females; mean age 43.4 ± 8.9 years) and 68 healthy controls matched for gender, age, and body mass index (BMI) were analyzed. The TBS was calculated in the lumbar region, based on two-dimensional (2D) projections of DXA assessments.

Results

TBS was 1.357 ± 0.129 in T1D patients and 1.389 ± 0.085 in controls (p = 0.075). T1D patients with prevalent fractures (n = 24) had a significantly lower TBS than T1D patients without fractures (1.309 ± 0.125 versus 1.370 ± 0.127, p = 0.04). The presence of fractures in T1D was associated with lower TBS (odds ratio = 0.024, 95 % confidence interval (CI) = 0.001–0.875; p = 0.042) but not with age or BMI. TBS and HbA1c were independently associated with fractures. The area-under-the curve (AUC) of TBS was similar to that of total hip BMD in discriminating T1D patients with or without prevalent fractures. In this set-up, a TBS cutoff <1.42 discriminated the presence of fractures with a sensitivity of 91.7 % and a specificity of 43.2 %.

Conclusions

TBS values are lower in T1D patients with prevalent fractures, suggesting an alteration of bone strength in this subgroup of patients. Reliable TBS cutoffs for the prediction of fracture risk in T1D need to be determined in larger prospective studies.

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Abbreviations

BMD:

Bone mineral density

BMI:

Body mass index

HbA1c :

Glycated hemoglobin A 1c

SD:

Standard deviation

TBS:

Trabecular bone score

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Acknowledgments

The authors thank Ernesta Palombo-Kinne (Jena) for critical revision of the manuscript.

Conflict of interest

TBS iNsight Software is a product of Med-Imaps. Didier Hans is co-owner of the TBS patent and has corresponding ownership shares. Thomas Neumann, Sabine Lodes, Bettina Kästner, Thomas Lehmann, Olivier Lamy, Ulrich Alfons Müller, Gunter Wolf, and Alexander Sämann declare that they have no conflict of interest.

Funding

The study was funded by a grant of Merck Pharma GmbH, Germany.

Author information

Authors and Affiliations

  1. Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany

    T. Neumann, S. Lodes, B. Kästner, U. A. Müller, G. Wolf & A. Sämann

  2. Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany

    T. Lehmann

  3. Bone Disease Unit, University of Lausanne, Lausanne, Switzerland

    D. Hans & O. Lamy

Authors
  1. T. Neumann
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  2. S. Lodes
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  3. B. Kästner
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  4. T. Lehmann
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  5. D. Hans
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  6. O. Lamy
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  7. U. A. Müller
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  8. G. Wolf
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  9. A. Sämann
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Corresponding author

Correspondence to T. Neumann.

Additional information

The study was conducted according to the principles of the Declaration of Helsinki.

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Neumann, T., Lodes, S., Kästner, B. et al. Trabecular bone score in type 1 diabetes—a cross-sectional study. Osteoporos Int 27, 127–133 (2016). https://doi.org/10.1007/s00198-015-3222-y

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  • DOI: https://doi.org/10.1007/s00198-015-3222-y

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