Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Wagner, A.
Trabecular Bone Score in non-diabetic, prediabetic and type II diabetic subjects
Humanmedizin; [ Diplomarbeit ] 5; 2017. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Obermayer-Pietsch Barbara
- Theiler-Schwetz Verena
- Altmetrics:
- Abstract:
- Introduction: Bone mineral density (BMD) in type II diabetes mellitus (T2DM) patients tends to be normal or even elevated, while the fracture risk is severely increased. The cause for this increase is assumed to be an enhanced risk of falls due to vascular complications but also a substantial change in bone texture and composition. Therefore, BMD as measured by dual energy X-ray absorptiometry (DXA), the current gold standard for diagnosing osteoporosis (OPO), should be supported by obtaining information on bone quality in terms of imaging and fracture risk assessment, whereas DXA-derived planar BMD only displays the quantity of bone mineralisation. The trabecular bone score (TBS) is a grey-level texture analysis derived from DXA scans of the lumbar spine and enables a more detailed picture of the biomechanical composition of bone. Thus, the predictive value of TBS for T2DM patients at risk for bone fractures requires a closer evaluation, including the utilization of parameters involved in bone and glucose metabolism. Materials & Methods: The data of 232 volunteers (86 male, 148 female) from the “BioPersMed cohort”, a longitudinal study cohort at the Division of Endocrinology and Diabetology and Cardiology at Medical University of Graz between 2010 and 2015, are used to calculate and assess potential associations between clinical (BMD, TBS, BMI, age), functional (oGTT) and biochemical parameters (hormones, bone markers, cholecalciferol). The cohort has been stratified for non-diabetic, pre-diabetic and diabetic participants according to their oGTT’s to evaluate glucose metabolism and its effects on bone from healthy individuals via intermediate to overt T2DM patients. Results: Prediabetes was characterized by a mild but significant reduction of TBS compared to non-diabetic patients, whereas the diabetic subgroup showed a more pronounced decrease. Furthermore, bone metabolism was found to be negatively associated to increased 2h-oGTT levels. Hormonal parameters such as FSH and LH were negatively associated with increased blood glucose levels. TSH, PTH and 25(OH) vitamin D did not show significant effects on glucose metabolism and imaging parameters. In addition, negative associations between impaired glucose control and bone markers (CTX, P1NP, OC, cholecalciferol), as well as postmenopausal elevated hormones (LH, FSH) have been found. PTH, TSH and testosterone did not show significant relations to TBS values. Discussion: Our findings suggest that TBS is a valid parameter for bone quality assessment in patients with T2DM, showing that both prediabetes and T2DM are negatively correlated to TBS in a progressive manner. The development pattern of TBS in prediabetes towards T2DM showed that even at an early stage bone structure is impaired, hence preventive efforts need to be in place as soon as possible. Other parameters, such as bone biomarkers or vitamin D might not have sufficient predictive value, probably to common vitamin D supplementation. Further studies and investigations, especially including age-adjusted TBS measurements, will clarify open questions in this complex, hence clinically important interaction.