Volumetric bone mineral density of the spine predicts mortality in African-American men with type 2 diabetes

Osteoporos Int. 2018 Sep;29(9):2049-2057. doi: 10.1007/s00198-018-4578-6. Epub 2018 May 31.


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 (women), 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; Bone mineral density; Gender; Mortality; Quantitative computed tomography; Type 2 diabetes; Vertebral fracture.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Black or African American / statistics & numerical data*
  • Bone Density / physiology*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Lumbar Vertebrae / physiopathology
  • Male
  • Middle Aged
  • North Carolina / epidemiology
  • Osteoporosis / ethnology*
  • Osteoporosis / mortality
  • Osteoporosis / physiopathology
  • Osteoporotic Fractures / ethnology
  • Osteoporotic Fractures / mortality
  • Osteoporotic Fractures / physiopathology
  • Spinal Fractures / ethnology*
  • Spinal Fractures / mortality
  • Spinal Fractures / physiopathology
  • Thoracic Vertebrae / physiopathology
  • Tomography, X-Ray Computed / methods