Two-thirds of women with type 2 diabetes mellitus (T2DM) have low bone mass and deteriorated microarchitecture, according to the new findings

In addition to aging, poor glycemic control may play an important role in remodeling, which may be associated with changes in bone strength in T2DM women," Dr. Fang-Ping Chen of Keelung Chang Gung Memorial Hospital in Keelung, Taiwan, and colleagues conclude in Menopause, online August 20.

T2DM increases a person's likelihood of osteoporotic fracture, boosting risk by up to 30%, but the mechanism involved remains unclear. Studies of bone mineral density (BMD) in T2DM patients have had mixed results, while studies using high-resolution peripheral quantitative computed tomography did not find significant evidence that women with T2DM have worse bone quality.

The authors looked at 289 consecutive postmenopausal patients with T2DM treated at their hospital between 2014 and 2015

Densitometry findings were normal in 36.8%, while 50.2% had osteopenia and 13% had osteoporosis. Bone architecture based on dual-energy x-ray absorptiometry (DXA) was normal in 27.4%, partially degraded in 55.4%, and degraded in 17.2%.

BMD at the lumbar spine, femoral neck and total hip correlated with a trabecular bone score (TBS), the authors found, and the normal, osteopenia and osteoporosis groups showed significant differences in TBS.

Age, vertebral fracture and bone-specific alkaline phosphatase were significantly different across TBS categories and T scores. The correlation between BMD and a vertebral fracture was weaker than with TBS, TBS plus BMD, fracture risk assessment tool score (FRAX), and TBS-adjusted FRAX.

"Based on clinically available and feasible methods (BMD, TBS, laboratory, and clinical assessment), this study confirmed that there is a relatively high frequency of compromised bone strength in T2DM postmenopausal women, which may be associated with a higher incidence of vertebral fracture," Dr. Chen and colleagues write.

"Regarding the strength of association with the vertebral fracture in T2DM postmenopausal women, FRAX or TBS- adjusted FRAX may hold promise as a low-cost and easily applicable tool that is currently available," they conclude.