Assessing Bone Health in Long-term Care Residents With Diabetes
Although older women with diabetes had higher femoral neck and lumbar spine bone mineral density (BMD), they also had a lower spine trabecular bone score (TBS) than older women without diabetes, according to a study of long-term care residents published online in the Journal of Osteoporosis.
BMD is often normal or above average in patients with type 2 diabetes, limiting its usefulness to assess osteoporosis fracture risk in a population with an increased incidence of fracture, the authors explained.
“TBS has been proposed as an index for quality of bone texture and microarchitecture,” wrote the research team, which was from the University of Pittsburgh in Pennsylvania. “As a determinant of bone strength, TBS can be used to predict fracture risk independent of BMD.”
The investigation used BMD and TBS to assess bone quality and skeletal health in long-term care residents with and without diabetes. The study included 511 residents, 433 of whom were women. Among women, 24% had a history of diabetes, 56% were prefrail or frail, and the average age was 80.6 years.
Women with diabetes had greater lumbar spine BMD (1.106 vs 1.017) and femoral neck BMD (0.695 vs 0.651) compared with women without diabetes, but their lumbar spine TBS was lower (1.211 vs 1.266), researchers reported. Total hip BMD was also higher in women with diabetes, although not statistically so.
Among the 78 men in the analysis, findings were similar but not statistically significant.
“Our study suggests that in older residents of long-term care facilities, diabetes mellitus has greater detrimental effects on bone microarchitecture, which may be missed by relying solely on BMD for assessment of bone health,” wrote corresponding author Nami Safai Haer, MD, of the division of geriatric medicine, and coauthors. “Measures of skeletal architecture such as TBS should be considered in all patients with diabetes mellitus.”
Reference:
Haeri NS, Kotlarczyk MP, Perera S, Greenspan SL. Diabetes mellitus is associated with poor bone microarchitecture in older adults residing in long-term care facilities. J Osteoporos. Published online December 19, 2022. doi:10.1155/2022/2522014
