2290-P: Sex-Specific Association of Bone Microstructure Marker with HbA1c and Markers of MASLD

Introduction and Objective: Type 2 diabetes and osteoporosis increase fracture risk and impair quality of life. The T-score from dual-energy X-ray absorptiometry, may overestimate bone density in metabolic dysfunction and does not reflect bone microarchitecture. The aim was to assess if the trabecular bone score (TBS) as a marker of bone microstructure relates to HbA1c and markers of metabolic dysfunction-associated steatotic liver disease (MASLD) (Fib-4 and APRI). Methods: TBS and lumbar T-scores were analyzed using TBSiNsight v3.1.2 and Hologic Horizon W. Subgroups based on HbA1c (<5.7%/≥5.7%) and Fib-4 (<1.3/≥1.3) were analysed with 2-way ANOVA and Spearman correlation. Results: The study included 101 males and 274 females (age 65 [54/72] years; HbA1c 5.5 [5.2/5.8] %; BMI 23.5 [21.0/26.1] kg/m²). At HbA1c ≥5.7%, TBS was 5% lower (P=0.0009) with no change in T-scores. Males with HbA1c ≥5.7% had 18% higher T-scores (P=0.0138), while females had 5% lower TBS (P=0.0004). At Fib-4 ≥ 1.3, TBS was 3% lower (P=0.0173) independently of sex, and reduced in females (P=0.0487). T-scores remained stable. In males, TBS inversely correlated with BMI (r=-0.3044; P=0.0027), Fib-4 (r=-0.2186; P=0.0333) and APRI (r=-0.2583; P=0.0015). In females, TBS correlated inversely with age (r=-0.3953; P<0.0001), HbA1c (r=-0.3046; P<0.0001), BMI (r=-0.1706; P=0.0074) and Fib-4 (r=-0.2049; P=0.0013). T-scores correlated with APRI in males (r=0.2074; P=0.0426) and with BMI (r=0.2371; P=0.0002) and APRI (r=-0.1412; P=0.0271) in females, but inversely with age (r=-0.1441; P=0.0241). Regression analysis showed age (P<0.001), HbA1c (P= 0.045) and BMI (P= 0.046) predicted TBS in females. BMI predicted T-score in both sexes (P<0.001). Conclusion: TBS is reduced at higher HbA1c and inversely associated with MASLD markers in males, while T-scores increased, highlighting the bone density and microarchitecture discrepancy. Findings emphasize the impact of prediabetes on bone metabolism and the relevance of sex-specific assessment in metabolic disease management. Disclosure V. Flegka: Other - Congress Sponsorship 12+13 September 2025; Ended; Ipsen Biopharmaceuticals, Inc. A. Sulaj: Research Support; Current; Novo Nordisk. Other - Speaker in scientific meetings; Current; Alexion Pharmaceuticals, Inc., Novo Nordisk. Research Support; Current; Takeda Pharmaceutical Company Limited, VectivBio AG.