This study investigates the determinants of fracture risk among patients with type 2 diabetes mellitus (T2D) in Saudi Arabia, focusing on the predictive value of trabecular bone score (TBS) in addition to conventional clinical and biochemical markers. A cohort of 1,188 individuals—581 with T2D and 607 without diabetes—was analyzed from Prince Sultan Military Medical City in Riyadh. All participants underwent detailed assessment including demographic data, glycated hemoglobin (HbA1c), serum creatinine, estimated glomerular filtration rate (eGFR), medication history, comorbidities such as rheumatoid arthritis and chronic obstructive pulmonary disease (COPD), and dual-energy X-ray absorptiometry (DXA) scans for lumbar spine bone mineral density (BMD) and TBS.
The overall prevalence of prior fractures was 9.4%, with a higher rate observed in the diabetic group (10.3%) compared to non-diabetics (8.6%). Despite no significant difference in mean BMD between the two groups (p = 0.347), patients with T2D exhibited a markedly increased fracture risk, highlighting the insufficiency of BMD alone in capturing skeletal fragility in this population. Logistic regression analysis revealed that female sex, use of teriparatide, abnormal TBS (partially degraded or degraded), and high FRAX scores incorporating TBS—specifically for major osteoporotic fractures (MOF) and hip fractures—were independent predictors of fracture across the entire cohort. In non-diabetic individuals, only teriparatide use and FRAX with TBS (MOF) remained significant. Among those with T2D, additional independent risk factors included older age, elevated serum creatinine, reduced eGFR, presence of osteopenia or osteoporosis, abnormal TBS, and high FRAX scores with TBS.
These results underscore that bone quality, as reflected by TBS, is a more accurate indicator of fracture risk than bone quantity in T2D. Abnormal TBS signifies microarchitectural degradation of the trabecular network, leading to compromised mechanical strength and increased susceptibility to low-trauma fractures—even when BMD appears normal or elevated.72741-87-8 web The integration of TBS into the FRAX algorithm significantly improves risk stratification, particularly in identifying high-risk individuals who would otherwise be classified as low risk based on BMD alone.16961-25-4 site
Furthermore, long-standing diabetes, poor glycemic control (elevated HbA1c), and renal dysfunction contribute to progressive deterioration of bone integrity through mechanisms involving advanced glycation end-products, oxidative stress, impaired osteoblast function, and altered bone turnover.PMID:20301631 These factors collectively diminish bone quality over time, increasing fracture vulnerability beyond what is predicted by traditional models.
The findings advocate for routine TBS measurement in clinical practice for patients with T2D, especially those over 50 years of age, with prolonged disease duration, or with multiple risk factors. Early identification enables timely implementation of targeted interventions, including pharmacological therapy, fall prevention programs, and lifestyle modification to reduce fracture incidence. While the study’s retrospective nature and single-center design limit broad generalizability, its large sample size and standardized methodology enhance internal validity. Future prospective, multicenter studies are essential to validate these findings and assess the long-term impact of TBS-guided management on fracture outcomes in diabetic populations.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com
