{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:36:59Z","timestamp":1793399819683,"version":"4.5.0"},"reference-count":52,"publisher":"The Endocrine Society","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Type 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Setting:<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures:<\/jats:title>\n                    <jats:p>Lumbar 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P &amp;lt; .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P &amp;lt; .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30\u20132.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P &amp;lt; .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\u20131.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24\u20131.38). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jc.2012-3118","type":"journal-article","created":{"date-parts":[[2013,1,23]],"date-time":"2013-01-23T02:25:54Z","timestamp":1358907954000},"page":"602-609","source":"Crossref","is-referenced-by-count":392,"title":["TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk"],"prefix":"10.1210","volume":"98","author":[{"given":"William D.","family":"Leslie","sequence":"first","affiliation":[{"name":"Department of Medicine (W.D.L.), University of Manitoba, Winnipeg, Canada R2H 2A6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bereng\u00e8re","family":"Aubry-Rozier","sequence":"additional","affiliation":[{"name":"Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Lamy","sequence":"additional","affiliation":[{"name":"Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Hans","sequence":"additional","affiliation":[{"name":"Lausanne University Hospital (B.A.-R., O.L., D.H.), 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Manitoba Bone Density Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"issue":"2","key":"2020071619410372700_B1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s11914-003-0011-x","article-title":"Burden of osteoporosis and fractures","volume":"1","author":"Keen","year":"2003","journal-title":"Curr Osteoporos Rep"},{"issue":"5","key":"2020071619410372700_B2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00198-004-1762-7","article-title":"Quality of life in patients with osteoporosis","volume":"16","author":"Lips","year":"2005","journal-title":"Osteoporos Int"},{"key":"2020071619410372700_B3","first-page":"1","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. 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