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Trabecular bone score in women with dysglycaemia and diabetes (#47)

Kara L Holloway 1 , Lelia LF de Abreu 1 , Mark A Kotowicz 1 2 3 , M.Amber Sajjad 1 , Julie A Pasco 1 2 3
  1. Deakin University, Geelong, VIC, Australia
  2. The University of Melbourne, Melbourne, VIC, Australia
  3. University Hospital Geelong, Geelong, VIC, Australia

Objectives:

Despite higher BMD, diabetes is associated with an increased fracture risk. This increased skeletal fragility may be due to poorer bone quality e.g. microarchitecture or material properties. Microarchitecture can be assessed using trabecular bone score (TBS) and this study aimed to describe the relationship between TBS and dysglycaemia in women.

Methods:

Women, aged 62.0±12.0 years (n=515), enrolled in the Geelong Osteoporosis Study were included in this study. Impaired fasting glucose (IFG) was defined as fasting plasma glucose (FPG) ≥5.5mmol/L and diabetes as FPG≥7.0mmol/L, use of antihyperglycaemic medication or self-report. Using TBS iNsight software (Version 2.1), TBS was determined retrospectively from lumbar spine DXA scans (Lunar Prodigy).

Using multivariable regression techniques the relationship between dysglycaemia and TBS was assessed, adjusting for age, height, lumbar spine BMD, diabetes medications and those affecting bone (e.g. bisphosphonates, glucocorticoids), alcohol intake, smoking, physical activity and socioeconomic status.

Results:

There were 382 women with normoglycaemia, 86 with IFG and 47 with diabetes. In the unadjusted model, both IFG and diabetes were associated with a lower TBS (p=0.032 and p<0.001, respectively). Mean TBS for normoglycaemia, IFG and diabetes were 1.282 (95%CI 1.267-1.297), 1.244 (1.213-1.275) and 1.158 (1.116-1.200), respectively.

In the adjusted model, diabetes was associated with lower TBS (p<0.001), however the association was attenuated for IFG (p=0.061) with mean adjusted TBS for normoglycaemia being 1.279 (95%CI 1.266-1.292); IFG 1.250 (1.222-1.277) and diabetes 1.108 (1.049-1.168). There was an interaction term for diabetes medications and age (p=0.012), however no interactions were identified between dysglycaemia status and age, height or BMD. Further adjustment for all other variables did not affect the relationship between dysglycaemia and TBS.

Conclusions:

Women with diabetes had lower TBS than those with normoglycaemia. Thus, degraded microarchitecture may contribute to the increased fracture risk in women with diabetes, independent of BMD.