Vertebral Fractures in Type 2 Diabetes Patients: Utility of Trabecular Bone Score and Relationship With Serum Bone Turnover Biomarkers

Yu Ching Lin, Jim Wu, Sheng Fong Kuo, Yun Chung Cheung, Chen Ming Sung, Chih Ming Fan, Fang Ping Chen*, Jennifer Ní Mhuircheartaigh

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

17 Scopus citations


Background: Patients with type 2 diabetes (T2D) have an increased risk for vertebral fracture (VF). The aim of this study is to determine the utility of trabecular bone score (TBS) in T2D patients with VF and the relationship of TBS with serum bone turnover biomarkers (SBTBs). Methodology: Postmenopausal T2D female patients were prospectively enrolled. All patients received: (1) dual-energy X-ray absorptiometry exam for bone mineral density (BMD), T-score, and TBS values; (2) lateral lumbar spine radiographs for VF assessment; and (3) SBTBs: bone specific alkaline phosphatase and Beta-C-Terminal telopeptides. BMD, T-score, TBS, and SBTBs were tested for association with VF. Results: The study included 285 T2D patients (mean age = 61.1 years) and 32 patients had VF (11.2%). TBS had the strongest association with VF in T2D patients (area under curve 0.775). The TBS cutoff values for VF are 1.279 in T-score ≥1 and 1.236 in T-score <−1. In patients without VF, all sites of BMD and TBS are significantly associated with SBTBs, but in patients with VF, no associations are found between SBTBs and all sites of BMD and TBS. Conclusions: TBS can assess bone quality in the spine. The low TBS cutoff values for T2D patients with VF imply T2D does impair bone quality. Thus, TBS should be incorporated in VF risk assessment in T2D patients. In addition, a dissociated relationship between BMD and TBS with SBTBs represents imbalanced bone turnover rate and results in bone fragility and VF.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalJournal of Clinical Densitometry
Issue number1
StatePublished - 01 01 2020

Bibliographical note

Publisher Copyright:
© 2019 The International Society for Clinical Densitometry


  • Bone mineral density
  • diabetes
  • fracture risk
  • serum bone turnover biomarkers
  • trabecular bone score


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