Abstract
<title>Abstract</title> <p>Background Although diabetic patients are generally at increased risk for osteoporosis and fractures, they paradoxically tend to exhibit relatively higher bone mineral density BMD T-scores. The trabecular bone score (TBS) has been shown to better gauge bone health in diabetic patients, frequently revealing deterioration that BMD fails to detect. This study aims to investigate the prevalence and determinants of the “TBS worse than BMD” discordance among diabetic patients aged 60 years and older in Iran. Methods This study was based on the data from the second phase of the first recruitment of the Bushehr Elderly Health (BEH) program. Dual-energy x-ray absorptiometry (DXA) was used for BMD measurement, and TBS iNsight software was used for TBS measurement. “TBS worse than BMD” discordance was defined as partially degraded TBS with normal BMD, or degraded TBS with normal BMD, or degraded TBS with osteopenia. The discordance prevalence was determined, and univariable and multivariable logistic regression analyses were performed to identify the factors associated with the discordance. Results Our study involved 439 diabetic participants, of whom 156 (35.54%) were men and 283 (64.46%) were women. The mean age (± SD) was 63.59 (± 7.75) years. The “TBS worse than BMD” discordance was observed in 75 (17.08%, 95% CI: 13.68, 20.94) subjects. The discordance was significantly more prevalent in women (20.85%, 95% CI: 16.22, 26.05) compared to men (10.25%, 95% CI: 5.97, 16.12). After adjusting for other variables, waist circumference emerged as the only significant determinant for the discordance (P < 0.001) at the α = 0.05 level. Every 1 cm increase in waist circumference increased the odds of discordance by 11% (OR: 1.11, 95% CI: 1.07, 1.15). Additionally, male sex (P = 0.08; OR = 0.50, 95% CI: 0.22, 1.10) and CRP level (P = 0.06; OR = 1.06, 95% CI: 1.00, 1.12) were significant determinants at the α = 0.10 level in the multivariable model. Conclusion The “TBS worse than BMD” discordance was present in approximately one-sixth of older adult diabetic patients, and the deteriorating bone quality in these individuals was only captured by TBS measurement. Our findings support incorporating TBS alongside BMD in fracture risk assessment, particularly among female diabetic patients and those with elevated waist circumference and CRP levels. Future longitudinal studies are needed to further elucidate the determinants and clinical outcomes of this discordance.</p>