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Type 2 diabetes is associated with higher trabecular bone density but lower cortical bone density: the Vietnam Osteoporosis Study

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Abstract

Summary

It is not clear why type 2 diabetes (T2D) has an increased risk of fracture despite higher areal bone mineral density. This study showed that compared with controls, T2D patients had higher trabecular bone density but lower cortical bone density, resulting in a lower bone strength.

Introduction

To define the association between type 2 diabetes and bone architecture and measures of bone strength.

Methods

The study was part of the Vietnam Osteoporosis Study, in which 1115 women and 614 men aged ≥ 30 were randomly recruited from Ho Chi Minh City. HbA1c levels were measured with analyzers ADAMS™ A1c HA-8160 (Arkray, Kyoto, Japan). The diagnosis of T2D was made if HbA1c was ≥ 6.5%. Trabecular and cortical volumetric bone density (vBMD) was measured in the forearm and leg by a pQCT XCT2000 (Stratec, Germany). Polar stress strain index (pSSI) was derived from the pQCT measurements. Difference in bone parameters between T2D and non-diabetic individuals was assessed by the number of standard deviations (effect size [ES]) by the propensity score analysis.

Results

The prevalence of T2D was ~ 8%. The results of propensity score matching for age, sex, and body mass index in 137 pairs of diabetic and non-diabetic individuals showed that T2D patients had significantly higher distal radius trabecular vBMD (ES 0.26; 95% CI, 0.02 to 0.50), but lower cortical vBMD (ES − 0.22; − 0.46 to 0.00) and reduced pSSI (ES − 0.23; − 0.47 to − 0.02) compared with non-diabetic individuals. Multiple linear regression analysis based on the entire sample confirmed the results of the propensity score analysis.

Conclusion

Compared with non-diabetic individuals, patients with T2D have greater trabecular but lower cortical vBMD which leads to lower bone strength.

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Acknowledgments

We sincerely thank Mrs. Tran Thi Ngoc Trang and Fr Pham Ba Lam for coordinating the recruitment of participants. We also thank doctors and medical students of the Pham Ngoc Thach University of Medicine for the data collection and clinical measurements.

Funding

This research is funded by Foundation for Science and Technology Development of Ton Duc Thang University (FOSTECT, http://fostect.tdt.edu.vn), 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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Authors and Affiliations

  1. Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam

    L.T. Ho-Pham, P.M.N. Chau, A.T. Do, H.C. Nguyen & T.V. Nguyen

  2. School of Biomedical Engineering, University of Technology Sydney (UTS), Sydney, Australia

    T.V. Nguyen

  3. Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia

    T.V. Nguyen

  4. St Vincent’s Clinical School, UNSW Sydney, Sydney, Australia

    T.V. Nguyen

Authors
  1. L.T. Ho-Pham
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  2. P.M.N. Chau
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  3. A.T. Do
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  4. H.C. Nguyen
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  5. T.V. Nguyen
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Corresponding author

Correspondence to L.T. Ho-Pham.

Ethics declarations

The study’s procedure and protocol were approved by the research and ethics committee of the People’s Hospital 115. The study was conducted according to the ethical principles of the Declaration of Helsinki, and all participants gave written informed consent.

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None.

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Ho-Pham, L., Chau, P., Do, A. et al. Type 2 diabetes is associated with higher trabecular bone density but lower cortical bone density: the Vietnam Osteoporosis Study. Osteoporos Int 29, 2059–2067 (2018). https://doi.org/10.1007/s00198-018-4579-5

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