Endocrine Abstracts

Introduction: Trabecular Bone Score (TBS) is a new non-invasive method to evaluate trabecular bone quality at the lumbar spine. The literature has contradictory results concerning the influence of insulin resistance and adipose tissue on bone, for this reason it is of interest to evaluate factors that determine bone health and risk of fracture in patients with T2DM.

Objective: To analyze the relationship between insulin resistance and adipose tissue with bone microarchitecture in patients with T2DM.

Materials and methods: Cross-sectional observational study. We included 137 T2DM patients,mean age 65.2 ± 7.5 years (58% male, 91% overweight/obese) and 300 non-diabetic controls. Demographic, anthropometric, clinical and biochemical variables were studied. To estimate whole-body fat percentage, we used a simple anthropometric linear equation named as the relative fat mass (RFM): 64 – (20 × height/waist circumference) + (12 × sex); sex = 0 for men and 1 for women. We determined bone mineral density in the lumbar spine, femoral neck and total hip by dual X-ray absorptiometry (DXA, Hologic QDR 4500), and TBS values using TBS iNsight Software, Med –Imaps, Pessac France). Statistical analysis was performed using the SPSS program (SPSS, inc, v 25.0)

Results: Patients with T2DM show significantly lower TBS values (1.08+ 0.18 vs 1.28 + 0.15 P < 0.000) despite of significantly higher lumbar BMD (LS-BMD) (1.05 + 0.20 vs 0.90 + 0.52 P < 0.001) compared to those without diabetes. TBS values were negatively correlated with body mass index (BMI) (P < 0.000),waist circumference (P < 0.000) and HOMA-2IR index (P = 0.004). However, no correlation was found between these parameters with LS-BMD. RFM was negatively correlated with both LS-BMD (P < 0.000) and TBS (P = 0.005) in patients with T2DM. In the multivariate analysis the association between TBS and insulin resistance parameters was maintained after adjusting for age and RFM.

Conclusions: This study shows that BMI, RFM, waist circumference, and insulin resistance are associated with lower TBS values in patients with T2DM. Our study suggests that central adiposity and its metabolic consequences negatively affect bone quality in these patients despite normal or increased bone density.