ArticleThe Journal of clinical endocrinology and metabolism2013
TBS (trabecular bone score) and diabetes-related fracture risk.
Article in The Journal of clinical endocrinology and metabolism, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 205 papers, 9 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effect of Simvastatin on Bone Density in Postmenopausal Women With Type 2 Diabetes: a Double-blind, Randomized Active-comparator (Ezetimibe) Controlled Clinical Trial
Study to Weigh the Effect of Exercise Training on BONE Quality and Strength (SWEET-BONE) in Type 2 Diabetes: an Exercise Intervention Program for Reducing the Risk of Fractures
Who cites it
205 citing papers in PubMed, 9 syntheses or guidelines pooled it, 416 citations in OpenAlex.
- Pooled it
- Trabecular bone score in adults with type 1 diabetes: a meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Pooled it
- Trabecular bone score in type 1 diabetes: a meta-analysis of cross-sectional studies.Journal of orthopaedic surgery and research · 2023Pooled it
- Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Pooled it
- [Diagnosis and management of patients with diabetes and co-existing osteoporosis (Update 2023) : Common guideline of the Austrian Society for Bone and Mineral Research and the Austrian Diabetes Society].Wiener klinische Wochenschrift · 2023Guideline
- Vertebral Fractures in Individuals With Type 2 Diabetes: More Than Skeletal Complications Alone.Diabetes care · 2020Pooled it
- Association between trabecular bone score and type 2 diabetes: a quantitative update of evidence.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Pooled it
- Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review.Endocrine · 2018Pooled it
- Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Pooled it
- Trial
- Romosozumab Improves Tissue Thickness-Adjusted Trabecular Bone Score in Women With Osteoporosis and Diabetes.The Journal of clinical endocrinology and metabolism · 2025Trial
- Efficacy of bisphosphonate therapy on postmenopausal osteoporotic women with and without diabetes: a prospective trial.BMC endocrine disorders · 2022Trial
- The effect of metformin versus placebo in combination with insulin analogues on bone mineral density and trabecular bone score in patients with type 2 diabetes mellitus: a randomized placebo-controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Trial
- VITamin D and OmegA-3 TriaL (VITAL) bone health ancillary study: clinical factors associated with trabecular bone score in women and men.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Trial
- Assessment of vertebral bone quality in women with type 2 diabetes mellitus using digital tomosynthesis.Skeletal radiology · 2026Article
- Prevalence and Associated Risk Factors of Osteoporosis in Community-Dwelling Older Adults in China: A Cross-Sectional Study of 2533 Participants.Medical science monitor : international medical journal of experimental and clinical research · 2026Article
- Osteoporosis and adult spinal deformity-a review for spinal surgeons by the SRS adult spinal deformity task force on senescence.Spine deformity · 2026Review
- Serum Periostin as a Complementary Biomarker of Frailty in Type 2 Diabetes: A Pilot Study Using the FRAIL Scale.International journal of molecular sciences · 2026Article
- The Obesity-Bone Paradox in Postmenopausal Women: Divergent Associations of BMI with Bone Mineral Density and Trabecular Bone Score in a Real-World DXA Cohort.Medicina (Kaunas, Lithuania) · 2026Observational
- Investigating the interrelationship of vitamin K and vitamin D status on bone density: results from the VITamin D and OmegA-3 TriaL.JBMR plus · 2026Article
145 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextType 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD.
objectiveThis study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. DESIGN AND
settingWe performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. PATIENTS: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes.
main outcome measuresLumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years).
resultsDiabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements.
conclusionsLumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.