TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk

被引:328
作者
Leslie, William D. [1 ]
Aubry-Rozier, Berengere [2 ]
Lamy, Olivier [2 ]
Hans, Didier [2 ]
机构
[1] Univ Manitoba, Dept Med, Winnipeg, MB R2H 2A6, Canada
[2] Univ Lausanne Hosp, CH-1011 Lausanne, Switzerland
关键词
MINERAL DENSITY; OSTEOPOROTIC FRACTURES; POSTMENOPAUSAL WOMEN; CAUCASIAN WOMEN; MICROARCHITECTURE; MELLITUS; BMD; OLDER; ASSOCIATION; HEALTH;
D O I
10.1210/jc.2012-3118
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. Objective: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. Design and Setting: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. Main Outcome Measures: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). Results: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. Conclusions: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD. (J Clin Endocrinol Metab 98: 602-609, 2013)
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页码:602 / 609
页数:8
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