Abstract: BACKGROUND: Type 2 diabetes patients have been shown to experience fractures in the normal range or even higher bone mineral density. Therefore, bone quality plays a more important role in predicting fracture risk than bone mineral density in type 2 diabetes patients.
OBJECTIVE: To evaluate the correlation of serum pentosidine level and trabecular bone score with the severity of vertebral fractures in type 2 diabetes patients.
METHODS: Eighty patients with with osteoporotic thoracolumbar fractures were selected from Shanghai Fifth People’s Hospital, Fudan University from January 2021 to June 2022, including 40 patients with type 2 diabetes and 40 patients without diabetes. General information about all patients, including gender, age, body mass index, and biochemical markers of bone metabolism, was collected. Bone mineral density was measured by dual-energy X-ray absorptiometry, and the trabecular bone fraction of the spine was calculated using TBS Insight® software from the images obtained from the measurement. The concentration of pentosidine in serum of patients was determined by high performance liquid chromatography. The degree of spinal fracture compression in all patients was graded using the Genant semi-quantitative classification. The correlation between various variables and the degree of vertebral fracture compression was analyzed.  
RESULTS AND CONCLUSION: (1) Compared with the non-diabetes group, the serum pentosidine level was significantly increased (P < 0.05) and the trabecular bone score was significantly decreased in the diabetes group (P < 0.05). There was no significant difference between the two groups in the lumbar bone mineral density, hip bone mineral density, and the proportion of severe fracture compression (P > 0.05). (2) Spearman correlation analysis showed that the severity of vertebral fracture was positively correlated with glycosylated hemoglobin and serum pentosidine levels (r=0.310, 0.796, P=0.005, 0.000). There was a significant negative correlation between vertebral fracture severity and trabecular bone score (r=-0.915, P=0.000). (3) These findings suggest that trabecular bone score and serum pentosidine levels, which can be used as a measure of bone quality, are significantly associated with the severity of osteoporotic vertebral fractures.

Key words: type 2 diabetes, osteoporosis, vertebral compression fracture, bone mineral density, pentosidine, trabecular bone score