title: TBS (trabecular bone score) and diabetes-related fracture risk.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada.
  
  
  METHODS
  We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes.
  
  
  METHODS
  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.
authors: Department of Medicine (C5121), St Boniface General Hospital, 409 Tache Avenue, Winnipeg, MB, Canada R2H 2A6. bleslie@sbgh.mb.ca
authors: William D
authors: WD
authors: Leslie
authors: Berengère
authors: B
authors: Aubry-Rozier
authors: Olivier
authors: O
authors: Lamy
authors: Didier
authors: D
authors: Hans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000209:etiology*; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012306:Risk; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology*