Lin, Yu-Ching; Wu, Jim; Kuo, Sheng-Fong; Cheung, Yun-Chung; Sung, Chen-Ming; Fan, Chih-Ming; Chen, Fang-Ping; Mhuircheartaigh, Jennifer Ní
Background Patients with Type 2 diabetes (T2D) have an increased risk for vertebral fracture (VF). The aim of this study is to determine the utility of trabecular bone score (TBS) in T2D patients with VF and the relationship of TBS with serum bone turnover biomarkers (SBTBs). Methodology Postmenopausal T2D female patients were prospectively enrolled. All patients received: (1) dual-energy X-ray absorptiometry exam for bone mineral density (BMD), T-score, and TBS values, (2) lateral lumbar spine radiographs for VF assessment, and (3) SBTBs: bone specific alkaline phosphatase (sBALP) and Beta-C-Terminal telopeptides (sCTX). BMD, T-score, TBS and SBTBs were tested for association with VF. Results The study included 285 T2D patients (mean age = 61.1 years) and 32 patients had VF (11.2%). TBS had the strongest association with VF in T2D patients (AUC 0.775). The TBS cutoff values for VF is 1.279 in T-score ≥ 1 and 1.236 in T-score < -1. In patients without VF, all sites of BMD and TBS are significantly associated with SBTBs, but in patients with VF, no associations are found between SBTBs and all sites of BMD and TBS. Conclusions TBS can assess bone quality in the spine. The low TBS cutoff values for T2D patients with VF implies T2D does impair bone quality. Thus, TBS should be incorporated in VF risk assessment in T2D patients. In addition, a dissociated relationship between BMD and TBS with SBTBs represents imbalanced bone turnover rate and results in bone fragility and VF.