Assessment of bone strength on the basis of bone mineral density (BMD) tends to miscalculate the risk of fracture in patients with diabetes mellitus (T2DM). Instead, with the help of trabecular bone score (TBS), bone fragility has been linked with decline in microstructure together with decreased BMD.

A retrospective cross-sectional study was conducted to determine which of the aforementioned factors are better associated with bone fragility. Overall, 548 patients with T2DM were enrolled - 257 postmenopausal women and 291 men over 50 years of age.

Investigators noted vertebral fractures (VFs) in 28.8% women and 39.5% men. There appeared to be a relationship between BMD and VFs in women with a BMD T-score ≤-1.0. Low TBS correlated with prevalent VFs. The correlation was independent of BMD in both genders, except for men with a BMD T-score > -1.0. The priority factor for determining VFs was TBS rather than BMD.

Therefore, in patients with diabetes, spinal microarchitecture as shown by TBS represented a predominant skeletal factor for bone fragility as compared to decline in bone mass, independent of BMD. A consolidated evaluation of bone strength using BMD and TBS could assist in the diagnosis of diabetic osteoporosis.

Source: Yamamoto M, Yamauchi M, Sugimoto T. Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus. PLoS One. 2019 Sep 16;14(9):e0222571.