Volumetric bone mineral density of the spine predicts
mortality in African-American men with type 2 diabetes
Received: 12 February 2018 /Accepted: 15 May 2018
International Osteoporosis Foundation and National Osteoporosis Foundation 2018
Summary The study showed that in African-American men with type 2 diabetes mellitus (T2D), vertebral volumetric bone
mineral density (vBMD) predicts all-cause mortality, independent of other risk factors for death.
Introduction Compared to European Americans, African Americans have lower rates of osteoporosis and higher rates of T2D.
The relationships between BMD and fractures with mortality are unknown in this population. The aim of this study was to
determine relationships between vertebral fractures and vertebral vBMD and mortality in African Americans with T2D.
Methods Associations between vertebral fractures and vBMD with all-cause mortality were examined in 675 participants with
T2D (391 women and 284 men) in the African American-Diabetes Heart Study (AA-DHS). Lumbar and thoracic vBMD were
measured using quantitative computed tomography (QCT). Vertebral fractures were assessed on sagittal CT images. Associations
of vertebral fractures and vBMD with all-cause mortality were determined in sex-stratified analyses and in the full sample.
Covariates in a minimally adjusted model included age, sex, BMI, smoking, and alcohol use; the full model was adjusted for
those variables plus cardiovascular disease, hypertension, coronary artery calcified plaque, hormone replacement therapy (wom-
en), African ancestry proportion, and eGFR.
Results After mean 7.6 ± 1.8-year follow-up, 59 (15.1%) of women and 58 (20.4%) of men died. In men, vBMD was inversely
associated with mortality in the fully adjusted model: lumbar hazard ratio (HR) per standard deviation (SD) = 0.70 (95% CI 0.52–
0.95, p = 0.02) and thoracic HR per SD = 0.71 (95% CI 0.54–0.92, p = 0.01). Only trends toward association between vBMD and
mortality were observed in the combined sample of men and women, as significant associations were absent in women. Vertebral
fractures were not associated with mortality in either sex.
Conclusions Lower vBMD was associated with increased all-cause mortality in African-American men with T2D, independent
of other risk factors for mortality including subclinical atherosclerosis.
Keywords African American
Quantitative computed tomography
Type 2 diabetes
Osteoporosis and type 2 diabetes mellitus (T2D) have high
morbidity and mortality. These disorders are increasing in
incidence and often coexist. Patients with T2D are at higher
risk of suffering an osteoporotic fracture [1, 2]. Secondary
analysis of three prospective observational studies, including
1199 men and 770 women with T2D, reported that individuals
with diabetes had a higher risk of hip and non-spine fractures
compared to age- and bone mineral density (BMD)-matched
controls . Mortality rates following hip fracture are also
higher in patients with T2D, compared to non-diabetics [3–5].
The relative contribution of BMD to increased mortality in
patients with T2D is difficult to determine. Many confounding
* L. Lenchik
Department of Radiology, Wake Forest School of Medicine, Medical
Center Boulevard, Winston-Salem, NC 27157-1053, USA
Department of Pathology, Wake Forest School of Medicine,
Winston-Salem, NC, USA
Department of Biostatistical Sciences, Division of Public Health
Sciences, Wake Forest School of Medicine, Winston-Salem, NC,
Department of Biochemistry, Wake Forest School of Medicine,
Winston-Salem, NC, USA
Department of Internal Medicine, Section on Nephrology, Wake
Forest School of Medicine, Winston-Salem, NC, USA