Objective(s): Last data showed advantages of TBS assessment of bone quality over BMD in patients with type 2 diabetes (T2D). We perform DXA in patients with T2D and calculated 10-year probability of fracture using FRAX® tool.
Material and methods: A total of 252 (172 females) T2D patients aged 36 to 86 y.o (mean 61.0±8.8) were examined. BMD was performed in 124 patients (110 females) using DXA (Lunar Prodigy, USA). BMD adjusted for TBS was calculated for 33 patients (10 male). Serum 25(OH)D (immunoassay) and iPTH (ELISA) levels assessed in 70 patients, HbA1c was determined by standard method.
Results: The study results showed that normal BMI had 20 (7.9%) patients, while 232 (92.1%) were overweight/obese. Mean HbA1c was 8.8±1.7%, diabetes duration was 130 years (13.1±6.4). More than 50% diabetic subjects were treated by insulin or in combination with antihyperglycemic drugs. Serum 25(OH)D level was between 7.5 and 44.5 ng/ml (22.7±9.4). Normal vitamin D status had 22.9%, 77.1% were insufficient/deficient. Negative correlation was found between 25(OH)D and iPTH (r=−0.37, P=0.002). We did not find association between 25(OH)D and glycemic control (HbA1c). Twenty four (9.5%) patients had fractures in their medical history, 31.5% patients had low BMD. BMD in patients with or without fractures was the same. 10-year probability of fractures calculation showed major osteoporotic fracture risk was from 0.4 to 24.0% (6.9±3.8) and hip fracture risk from 0 to 15.0% (0.9±1.5). Fracture risk was associated with age (r=0.40, P=0.0001) and BMI (r=−0.20, P=0.001), and didnt associate with diabetes duration and type of medications, HbA1c, 25(OH)D or iPTH levels. TBS was from 1.02 to 1.53 (mean 1.28±0.1). Twenty two (66.7%) patients, including 5 men, had BMD lower than 1.35 g/cm2. DXA results showed decreased BMD only in 10 diabetic patients, while using TBS data 22 of diabetic patients had impaired bone quality. FRAX score showed that 10-year probability of hip fracture or major osteoporotic fracture risks did not clinically differ (0.8% & 0.6%; 8.5% & 7.4%) when we used or did not use TBS.
Conclusion(s): Study results showed that patients with T2D had obesity, low serum 25(OH)D level and normal BMD in most cases. BMD in patients with or without fractures did not differ. Using BMD adjusted for TBS identified decreased bone quality in sixty seven percent of T2D patients.
18 - 21 May 2019
European Society of Endocrinology