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Bone microstructure and TBS in diabetes : what have we learned? A narrative review

Ferrari, S. ; Akesson, K. E. LU ; Al-Daghri, N. ; Biver, E. ; Chandran, M. ; Chevalley, T. ; Josse, R. ; Kendler, D. ; Lane, N. E. and Makras, P. , et al. (2025) In Osteoporosis International 36(7). p.1115-1128
Abstract

Abstract: Diabetes is associated with an increased risk of fracture. Areal bone mineral density (aBMD), the most reliable indicator of fracture risk in healthy adults, is low in patients with type 1 diabetes mellitus but normal or high in patients with type 2 diabetes mellitus. Most trabecular and cortical parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are lower in type 1 diabetes and higher in type 2 diabetes, in parallel with aBMD. In contrast, lumbar spine trabecular bone score (TBS) has been reported to be lower in women with both type 1 and type 2 diabetes. The discordance between improved bone microstructure and degraded TBS reflects the effect of central obesity (currently the subject... (More)

Abstract: Diabetes is associated with an increased risk of fracture. Areal bone mineral density (aBMD), the most reliable indicator of fracture risk in healthy adults, is low in patients with type 1 diabetes mellitus but normal or high in patients with type 2 diabetes mellitus. Most trabecular and cortical parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are lower in type 1 diabetes and higher in type 2 diabetes, in parallel with aBMD. In contrast, lumbar spine trabecular bone score (TBS) has been reported to be lower in women with both type 1 and type 2 diabetes. The discordance between improved bone microstructure and degraded TBS reflects the effect of central obesity (currently the subject of a revision to the TBS algorithm). Meanwhile, evidence supports use of TBS in conjunction with aBMD and/or FRAX for improved fracture prediction in patients with type T2D. Summary: This position paper, on behalf of the Bone and Diabetes Working Group of the International Osteoporosis Foundation, summarizes alterations in bone microarchitecture measured by HR-pQCT in diabetes. It also addresses the technical and clinical considerations of the trabecular bone score, particularly discussing the significance of this measurement in individuals with diabetes and the influence of abdominal fat.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bone Microstructure, Diabetes, HRpQCT, Trabecular Bone Score (TBS)
in
Osteoporosis International
volume
36
issue
7
pages
14 pages
publisher
Springer
external identifiers
  • scopus:105004890428
  • pmid:40353870
ISSN
0937-941X
DOI
10.1007/s00198-025-07495-0
language
English
LU publication?
yes
id
a40d670b-81dd-465a-808a-df6c85b0dde3
date added to LUP
2025-09-26 14:54:07
date last changed
2025-10-14 10:16:37
@article{a40d670b-81dd-465a-808a-df6c85b0dde3,
  abstract     = {{<p>Abstract: Diabetes is associated with an increased risk of fracture. Areal bone mineral density (aBMD), the most reliable indicator of fracture risk in healthy adults, is low in patients with type 1 diabetes mellitus but normal or high in patients with type 2 diabetes mellitus. Most trabecular and cortical parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are lower in type 1 diabetes and higher in type 2 diabetes, in parallel with aBMD. In contrast, lumbar spine trabecular bone score (TBS) has been reported to be lower in women with both type 1 and type 2 diabetes. The discordance between improved bone microstructure and degraded TBS reflects the effect of central obesity (currently the subject of a revision to the TBS algorithm). Meanwhile, evidence supports use of TBS in conjunction with aBMD and/or FRAX for improved fracture prediction in patients with type T2D. Summary: This position paper, on behalf of the Bone and Diabetes Working Group of the International Osteoporosis Foundation, summarizes alterations in bone microarchitecture measured by HR-pQCT in diabetes. It also addresses the technical and clinical considerations of the trabecular bone score, particularly discussing the significance of this measurement in individuals with diabetes and the influence of abdominal fat.</p>}},
  author       = {{Ferrari, S. and Akesson, K. E. and Al-Daghri, N. and Biver, E. and Chandran, M. and Chevalley, T. and Josse, R. and Kendler, D. and Lane, N. E. and Makras, P. and Meier, C. and Mithal, A. and Suzuki, A. and Vasikaran, S. and Pierroz, D. D. and Leslie, W.}},
  issn         = {{0937-941X}},
  keywords     = {{Bone Microstructure; Diabetes; HRpQCT; Trabecular Bone Score (TBS)}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1115--1128}},
  publisher    = {{Springer}},
  series       = {{Osteoporosis International}},
  title        = {{Bone microstructure and TBS in diabetes : what have we learned? A narrative review}},
  url          = {{http://dx.doi.org/10.1007/s00198-025-07495-0}},
  doi          = {{10.1007/s00198-025-07495-0}},
  volume       = {{36}},
  year         = {{2025}},
}