Oral Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Bone mineral density and trabecular bone score values in novel subgroups of adult-onset diabetes (#11)

Jacob W Harland 1 , Kimberly Cukier 2 , Anna Lonie 2 3 , Mark A Kotowicz 1 2 4 , Julie A Pasco 1 2 4 5 , Kara L Holloway-Kew 1
  1. Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Victoria
  2. University Hospital Geelong, Barwon Health, Geelong, Victoria
  3. Deakin University School of Medicine, Geelong, Victoria
  4. Department of Medicine, The University of Melbourne, Melbourne, Victoria
  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria

Background:

Individuals with diabetes are heterogenous and recently new, more subgroupings have been proposed (1). These are: mild age-related diabetes (MARD), mild obesity-related diabetes (MOD), severe insulin-resistant diabetes (SIRD), severe insulin-deficient diabetes (SIDD), and severe autoimmune diabetes (SAID). Little is known about how bone health varies between these groups. This study investigated differences in bone health between these subgroups and normoglycaemia.

Methods:

Male participants (n=895, 20-97yr) were drawn from the Geelong Osteoporosis Study. Diabetes (n=105) was defined as fasting plasma glucose≥7.0mmol/L, self-report and/or use of antihyperglycaemic medication. Using hierarchical clustering, men with diabetes were categorised into the SAID subgroup (positive glutamic acid decarboxylase antibodies, n=3), and using K-means clustering, those remaining were categorised into the other subgroups. The Lunar DPX-L and the GE-Prodigy were used to measure bone mineral density (BMD). Lumbar spine DXA scans were assessed for trabecular bone score (TBS) using TBS iNsight software (Version 2.2). ANOVA and linear regression were used to identify differences in BMD and TBS. The SAID group was excluded from regression analyses due to low numbers.

Results:

The subgroups in this study were defined as MARD (n=25, mean age±SD, 80.2±4.5yr), MOD (n=30, 68.4±3.8yr), SIRD (n=31, 58.2±3.1yr), SIDD (n=16, 45.8±6.0yr), and SAID (n=3, 27.0±11.5yr) (Table). Unadjusted femoral neck BMD was lower in the MARD group compared to normoglycaemia; this was not significant after adjusting for age (Table). Adjusting for weight lowered BMD values in the subgroups. No other intergroup differences were observed for BMD. Unadjusted TBS was lower in all subgroups compared to normoglycaemia. Only the SIDD group remained lower (1.557(1.440-1.675)vs1.672(1.586-1.758), p=0.003) after adjusting for age and weight.

Conclusion:

Differences were observed for unadjusted TBS, however, only the SIDD group sustained this difference after adjustment. These results may guide diabetes management strategies regarding bone health, focussing interventions on the subgroups with poorer bone health.

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  1. 1. Ahlqvist E, Storm P, Käräjämäki A, Martinell M, Dorkhan M, Carlsson A, Vikman P, Prasad RB, Aly DM, Almgren P, Wessman Y, Shaat N, Spégel P, Mulder H, Lindholm E, Melander O, Hansson O, Malmqvist U, Lernmark Å, Lahti K, Forsén T, Tuomi T, Rosengren AH, Groop L. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol 2018;6:361-369