Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review

Association between sensitivity to thyroid hormones and trabecular bone score in euthyroid individuals: a population-based cross-sectional study

BACKGROUND

Thyroid hormone is a known pivotal factor that affects bone metabolism; however, whether bone microarchitecture is associated with thyroid hormone sensitivity is poorly understood. The trabecular bone score (TBS) serves as an essential indicator for assessing bone microarchitecture. This study aimed to investigate the relationship between sensitivity to thyroid hormones and TBS in euthyroid individuals.

METHODS

This cross-sectional study involved 3320 euthyroid participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Data, including thyroid function, TBS and other related parameters, were extracted and analyzed. The indices of thyroid hormone sensitivity, including the thyrotropin thyroxine resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), thyroid feedback quantile-based index (TFQI) and parametric thyroid feedback quantile-based index (PTFQI), were calculated. Greater values of these indicators indicated a greater degree of impaired thyroid hormone sensitivity.

RESULTS

Impaired sensitivity to thyroid hormones was associated with degraded bone microarchitecture following adjustments for confounding variables (TT4RI: P = 0.005, TSHI: P = 0.008, TFQI: P = 0.003 and PTFQI: P = 0.006). The restricted cubic spline model demonstrated a positive relationship between TT4RI, TSHI, TFQI, PTFQI and degraded bone microarchitecture. Similar findings were observed in the analysis of subgroups stratified by age, sex, race, diabetes status, hypertension status and hyperuricemia status.

CONCLUSIONS

In euthyroid individuals, impaired sensitivity to thyroid hormones is associated with degraded bone microarchitecture. However, further studies are required to confirm this relationship.

The study findings demonstrated a significant association between C-reactive protein levels and trabecular bone score : NHANES 2005-2008

OBJECTIVES

The association between C-reactive protein and bone density has been primarily investigated in previous studies, with little to no research investigating its relationship with total bone trabecular score.

METHODS

Data from the NHANES database (500 males and 633 females) were utilized in this study to perform a multiple weighted linear regression analysis to estimate this relationship of CRP and TBS. Subsequently, population characterization, univariate logistic regression analysis, subgroup and interaction analysis were in progress.

RESULTS

Upon covariate adjustment, the analysis revealed a notable negative correlation between CRP and TBS(β=-0.0081,95% CI (-0.0142, -0.0019), P = 0.009). Furthermore, no interactions were detected within any subgroups.

CONCLUSION

This finding enhances our comprehension of the relationship in inflammation and bone health, offering the novel research outlook for the treatment and prevention of osteoporosis and osteoporotic fractures.

The Value of Mandibular Indices on Cone Beam Computed Tomography in Secondary Causes of Low Bone Mass

Background: As implant treatment cases increase, many cases of failure/side effects also occur. Generally, dental clinics determine the density of the jawbone using cone beam CT (CBCT). Considering the known potential role of this tool for bone assessment in primary osteoporosis, this study evaluated patients with secondary endocrine causes of low bone mass. Methods: The study included 83 patients with endocrine causes of osteoporosis who were evaluated by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and mental foramen (MF) region CBCT. The following CBCT indices were measured: anterior (A)-thickness of inferior mandibular cortex 10 mm anterior from MF; molar (M)-thickness of inferior mandibular cortex 10 mm posterior from MF; posterior (P)-thickness of inferior mandibular cortex 25 mm posterior from MF; symphysis (S)-thickness of inferior mandibular cortex equidistant from the centers of right and left MF. Results: The highest correlation coefficient in the secondary causes group was between the A index and the lumbar BMD (r = 0.375, p = 0.001) and the P index and the femoral neck BMD (r = 0.38, p = 0.001). Hypercortisolism seems to be the most predictable cause of secondary osteoporosis using the A, M, and P indices. The A, M, and P indices showed predictive values of the bone micro-architecture that was evaluated using TBS score, and were statistically significant. The symphysis index does not significantly predict osteoporosis or impaired bone micro-architecture. Conclusions: These findings support the potential usefulness of A, M, and P CBCT-derived radiomorphometric mandibular indices in secondary osteoporosis, underlining the well-known effects of these pathologies on bone micro-architecture rather than bone quantity.

Osteoporosis as the Female-Specific Risk Factor for Dynapenia in Elderly Patients with Type 2 Diabetes

Aims: Dynapenia is a noteworthy health issue contributing to increased risk of falling, but its co-occurrence with osteoporosis in elderly individuals with type 2 diabetes mellitus (T2DM) has not been well explored. Therefore, this study aimed to establish the association between osteoporosis and dynapenia, focusing on T2DM females due to their high prevalence of osteoporosis and fragility. Methods: We conducted a cross-sectional study to recruit a total of 103 T2DM patients (43 males and 60 females), aged between 50 and 80 years with median 68.0 years. Dual-energy X-ray absorptiometry (DXA) and dominant hand grip strength measurements were performed to define body composition, osteoporosis, and dynapenia in a sex-specific manner. Results: Higher prevalence of dynapenia and dyna-osteoporosis was observed in female T2DM patients with a significantly positive correlation between osteoporosis and dynapenia even after adjustment of body mass index (BMI). By performing a multivariate logistic regression analysis, both BMI and osteoporosis were identified as risk predictors for the development of dynapenia in female T2DM patients with odds ratios (95% CIs) of 1.234 (1.029-1.480) and 4.883 (1.352-17.630), respectively. Conclusions: Our results point out there is high, female-specific co-occurrence of osteoporosis and dynapenia in T2DM patients. Moreover, having osteoporosis and increased BMI might boost the risk of dynapenia in elderly females with T2DM.

Glucagon-like Peptide-1 Receptor Agonists and Diabetic Osteopathy: Another Positive Effect of Incretines? A 12 Months Longitudinal Study

Diabetic osteopathy is a frequent complication in patients with type 2 diabetes mellitus (T2DM). The association between T2DM and increased fracture risk has led to study the impact of new antidiabetic drugs on bone metabolism. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin mimetic drugs which have many pleiotropic properties. The relationship between GLP-1RAs and bone is very complex: while in vitro and animal studies have demonstrated a protective effect on bone, human studies are scarce. We led a 12 months longitudinal study evaluating bone changes in 65 patients withT2DM for whom a therapy with GLP-1RAs had been planned. Fifty-four T2DM patients completed the 12-month study period; of them, 30 had been treated with weekly dulaglutide and 24 with weekly semaglutide. One-year therapy with GLP-1RAs resulted in a significant reduction in weight and BMI. Bone mineral density (BMD), bone metabolism, trabecular bone score (TBS), adiponectin, and myostatin were evaluated before and after 12 months of GLP-1RAs therapy. After 12 months of therapy bone turnover markers and adiponectin showed a significant increase, while myostatin values showed a modest but significant reduction. BMD-LS by DXA presented a significant reduction while the reduction in BMD-LS by REMS was not significant and TBS values showed a marginal increase. Both DXA and REMS techniques showed a modest but significant reduction in femoral BMD. In conclusion, the use of GLP-1RAs for 12 months preserves bone quality and reactivates bone turnover. Further studies are needed to confirm whether GLP-1RAs could represent a useful therapeutic option for patients with T2DM and osteoporosis.

Age and sex are excellent predictors of bone complications in patients with type 2 diabetes with no history of osteoporotic fracture or treatment for osteoporosis

OBJECTIVE

To identify patients with type 2 diabetes mellitus (T2DM) with no history of fracture or osteoporosis treatment who are at risk of bone complications through the assessment of bone quality and quantity.

METHODS

Of the outpatients attending our clinic during 2021 to 2022, we retrospectively enrolled 137 (men/women: 85/52, median age: 65 years) consecutive patients aged ≥40 years who had T2DM but no history of fracture or osteoporosis treatment. The lumbar spine and femoral neck bone mineral density and the trabecular bone score were determined using dual-energy X-ray absorptiometry. Independent factors associated with bone disease were identified using logistic regression analysis, and odds ratios (ORs) were calculated.

RESULTS

Age and female sex were significantly associated with high ORs for development of bone disease. The integrated risk of bone complications was nearly 40-fold higher in older (≥65 years) women than in younger (<65 years) men. This difference remained after adjustment for the duration of T2DM, body mass index, and HbA1c level.

CONCLUSIONS

Older women have the highest risk of osteopenia and osteoporosis among patients with T2DM who have no history of fracture or osteoporosis treatment. These patients should undergo intensive monitoring for bone fragility from an early stage of their disease.

Diabetic Rats Induced Using a High-Fat Diet and Low-Dose Streptozotocin Treatment Exhibit Gut Microbiota Dysbiosis and Osteoporotic Bone Pathologies

Type 2 diabetes mellitus (T2DM) presents a challenge for individuals today, affecting their health and life quality. Besides its known complications, T2DM has been found to contribute to bone/mineral abnormalities, thereby increasing the vulnerability to bone fragility/fractures. However, there is still a need for appropriate diagnostic approaches and targeted medications to address T2DM-associated bone diseases. This study aims to investigate the relationship between changes in gut microbiota, T2DM, and osteoporosis. To explore this, a T2DM rat model was induced by combining a high-fat diet and low-dose streptozotocin treatment. Our findings reveal that T2DM rats have lower bone mass and reduced levels of bone turnover markers compared to control rats. We also observe significant alterations in gut microbiota in T2DM rats, characterized by a higher relative abundance of Firmicutes (F) and Proteobacteria (P), but a lower relative abundance of Bacteroidetes (B) at the phylum level. Further analysis indicates a correlation between the F/B ratio and bone turnover levels, as well as between the B/P ratio and HbA1c levels. Additionally, at the genus level, we observe an inverse correlation in the relative abundance of Lachnospiraceae. These findings show promise for the development of new strategies to diagnose and treat T2DM-associated bone diseases.