Assessment of fracture risk in climacteric women with type 2 diabetes mellitus: comparison between Trabecular Bone Score, Hip Structural Analysis and FRAX

Objective: Patients affected by type 2 diabetes mellitus (T2DM) have an increased risk of fragility fractures, compared with non- diabetic subjects, despite normal or higher bone mineral density (BMD) values. An additional attempt to go beyond the limitations of DXA was the introduction of different DXA-based software, such as Hip Structural Analysis (HSA) and Trabecular Bone Score (TBS), that provide an indirect index of the strength of trabecular architecture and are considered a better predictor of fracture risk than BMD, especially in case of secondary osteoporosis. The aim of the present study was to evaluate the performance of HSA and TBS in well-compensated T2DM climacteric women and their fracture prediction capability, compared to FRAX. Methods: We performed a cross-sectional population-based study, analyzing lumbar spine and femoral BMD, HSA, TBS and FRAX values, in a population of climacteric women consisting of 119 subjects affected by T2DM and 119 controls. The two groups were comparable for age, menopause age, Body Mass Index (BMI). Prevalence of previous clinical fractures was 11.8% and 5.9% respectively. Results: No significant differences emerged between BMD, FRAX and FRAX adjusted for TBS values in the two groups. Multivariate analysis showed that TBS value was the only variable associated with T2DM; in particular, data demonstrated that the lower was TBS and the more probable was the diabetic condition. In add- ition, the median value of lumbar spine TBS was significantly lower in women with T2DM than in controls (1.174 vs 1.220). No significant differences in HSA parameters were observed between the two subgroups.Conclusions: Our results showed that, between subjects affected by T2DM and controls, the only prognostic factor capable to characterize climacteric diabetic patients was TBS