Association between trabecular bone score and type 2 diabetes: a quantitative update of evidence



Patients with type 2 diabetes have an increased risk of fracture despite having a higher areal bone mineral density. This meta-analysis showed that compared with controls, diabetic patients had a lower trabecular bone score (TBS) than non-diabetic individuals, suggesting that TBS can be a useful measurement for the assessment of fracture risk in diabetic patients.


The association between type 2 diabetes and trabecular bone score (TBS) has not been clear. The present study sought to answer the specific question of whether patients with type 2 diabetes have a lower TBS than those without diabetes.


Using electronic and manual search, we identified 12 studies that had examined the association between type 2 diabetes and TBS between 2013 and 2019. These studies involved 35,546 women and 4962 men aged 30 years and older. We extracted the mean and standard deviation of TBS for patients with and without diabetes. The synthesis of effect sizes was done by the random effects meta-analysis model.


Patients with diabetes had significantly lower TBS than those without diabetes, with standardized mean difference being − 0.31 (95% CI, − 0.45 to − 0.16). The difference was greater in women (− 0.50; 95% CI, − 0.69 to − 0.32) than in men (− 0.04; 95% CI, − 0.17 to 0.10). Compared with normal individuals, those with prediabetes had significantly lower TBS (d = − 0.13; 95% CI, − 0.23 to − 0.04; P = 0.005). There was heterogeneity between the studies, with the index of inconsistency (I2) ranging from 92% (in women) to 69.5% (in men).


Patients with type 2 diabetes have a lower TBS than non-diabetic individuals, suggesting that TBS can be a useful measurement for the assessment of fracture risk in diabetic patients.

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This research is funded by Foundation for Science and Technology Development of Ton Duc Thang University (FOSTECT,, grant number FOSTECT.2014.BR.09, and a grant from the Department of Science and Technology of Ho Chi Minh City.

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Correspondence to L. T. Ho-Pham.

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Ho-Pham, L.T., Nguyen, T.V. Association between trabecular bone score and type 2 diabetes: a quantitative update of evidence. Osteoporos Int 30, 2079–2085 (2019).

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  • Bone mineral density
  • Meta-analysis
  • Trabecular bone score
  • Type 2 diabetes