Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease

Shanbhogue, Vikram Vinod; Hansen, Stinus; Frost, Morten; Jørgensen, Niklas Rye; Hermann, Anne Pernille; Henriksen, Jan Erik; Brixen, Kim

doi:10.1530/eje-15-0860

Cited by 160 publications

(130 citation statements)

References 38 publications

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“…In agreement with Patsch et al, we report that women with fracture had higher porosity than those without fracture, while women with T2DM had lower porosity than nondiabetic women. Moreover, cortical porosity is suggested to be increased only in T2DM patients with microvascular complications, however, one limitation in that study was that fracture status was not taken into account [34]. They reported no correlation between bone structure and duration of disease, which is in agreement with our findings of a non-significant association between cortical porosity and diabetes duration.…”

Section: Discussionsupporting

confidence: 84%

“…These data suggest a tendency towards increased cortical porosity of the distal radius in women with T2DM in studies with limited number of participants using HR-pQCT. However, the absolute differences in cortical porosity between those with and without T2DM were small, and the cortical thickness was below 1 mm at the distal radius [11][12][13]34]. Moreover, HR-pQCT present low values of porosity (1-15%) because of quantifying only porosity of the compact cortices and only pores over 100 µm in diameter, and the threshold based segmentation may misclassify trabecularised cortical bone as trabecular bone [23,24,26,32].…”

Section: Discussionmentioning

confidence: 99%

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Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Osima

Kral

Borgen

et al. 2017

Bone

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Increased cortical porosity has been suggested as a possible factor increasing fracture propensity in patients with type 2 diabetes mellitus (T2DM). This is a paradox because cortical porosity is generally associated with high bone turnover, while bone turnover is reduced in patients with T2DM. We therefore wanted to test the hypothesis that women with T2DM have lower bone turnover markers (BTM) and lower cortical porosity than those without diabetes, and that higher serum glucose and body mass index (BMI) are associated with lower BTM, and with lower cortical porosity. Increasing glucose and BMI were associated with lower bone turnover suggesting that reduced intracortical and endocortical remodeling leads to reduced porosity and thicker cortices. Using low-resolution clinical CT, cortical porosity was lower in women with T2DM compared to 3 women without diabetes. This indicates that other changes in bone qualities, not increased cortical porosity, are likely to explain the increased fracture propensity in patients with T2DM.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Osima

Kral

Borgen

et al. 2017

Bone

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“…Indeed, MRI studies revealed greater cortical porosity in individuals with T2DM compared with nondiabetic controls, 61,62 a finding repeated by a study using quantitative CT (Xtreme-CT), especially in those with fractures and/or microvascular complications. [6][7][8][9] Recent diagnostic advances enable the measurement of in vivo bone material strength (BMS) by the minimally invasive, bone microindentation testing. 7,63 Postmenopausal women with T2DM demonstrated lower BMS and greater radial cortical porosity.…”

Section: T2dmmentioning

confidence: 99%

“…The presence of microvascular complications in DM have also been associated with reduction of BMD in T1DM 5 and with bone micro-architectural abnormalities in T2DM. [6][7][8][9] Increasing evidence shows the interaction between plasma glucose levels and bone metabolism, revealing mechanisms through which bone fragility may develop in DM. Whether this interaction translates into increased risk for fragility fractures and decreased BMD in all DM populations remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Bone Metabolism and Fracture Risk in Diabetes Mellitus

Puspitasari¹,

Purnamasari²,

Setyohadi³

et al. 2017

JAFES

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Individuals with Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are at increased risk for fragility fractures. Bone mineral density (BMD) is decreased in T1DM but often normal or even elevated in T2DM when compared with age-matched non-DM populations. However, bone turnover is decreased in both T1DM and T2DM. The pathophysiologic mechanisms leading to bone fragility is multifactorial, and potentially leads to reduced bone formation, altered bone microstructure and decreased bone strength. Interestingly, different antidiabetic treatments may influence fracture risk due to effects on glycemic control, triggering of hypoglycemic events or osteoblastogenesis.

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“…There is decreased cortical thickness and volumetric BMD (vBMD), with increased cortical porosity and pore size in T2DM [44] patients with microvascular disease (retinopathy, neuropathy or nephropathy). These changes are associated with decreased bone strength by finite element analysis [44,45] and are greater in T2DM patients with previous fractures [46], suggesting that they may be clinically significant contributors to fracture risk.…”

Section: Type 2 Diabetes Fracture and Bmdmentioning

confidence: 99%

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

cho¹,

Lee²,

Kang³

2017

Exerc Sci

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clinicians. However, the limited available evidence suggests that osteoporosis treatment does reduce fracture risk in obesity and T2DM with generally similar efficacy to other patients.Keywords Bone · Obesity · Diabetes · Fat · Fracture Obesity, Type 2 Diabetes and BoneObesity is a major and growing public health problem; for example, in the UK, 40% of adults will be obese by 2025 [1]. Obesity is the most important risk factor for type 2 diabetes (T2DM), and the global prevalence of T2DM is likely to be 592 million by 2035 [2]. As the population ages, the burden of osteoporosis and fragility fracture also increases. Obesity and T2DM have effects on fracture risk, and fractures in T2DM are associated with greater morbidity than in the general population. Understanding how to assess and treat fracture risk in these groups is important for health care planning and individual patients. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable in the broader study of osteoporosis, such as the effects of adipokines on bone cells and the effects of collagen glycation on material properties of bone. There are some similarities in the effect of obesity and T2DM on bone, but some important differences such as cortical porosity and collagen glycation.In this review, we describe the effects of obesity and T2DM on fracture risk and discuss possible mechanisms of their effects. We also consider the validity of existing fracture risk prediction tools and efficacy of osteoporosis treatment in these patient groups. AbstractIn an increasingly obese and ageing population, type 2 diabetes (T2DM) and osteoporotic fracture are major public health concerns. Understanding how obesity and type 2 diabetes modulate fracture risk is important to identify and treat people at risk of fracture. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable to osteoporosis in the general population. Most available evidence indicates lower risk of proximal femur and vertebral fracture in obese adults. However the risk of some fractures (proximal humerus, femur and ankle) is higher, and a significant number fractures occur in obese people. BMI is positively associated with BMD and the mechanisms of this association in vivo may include increased loading, adipokines such as leptin, and higher aromatase activity. However, some fat depots could have negative effects on bone; cytokines from visceral fat are pro-resorptive and high intramuscular fat content is associated with poorer muscle function, attenuating loading effects and increasing falls risk. T2DM is also associated with higher bone mineral density (BMD), but increased overall and hip fracture risk. There are some similarities between bone in obesity and T2DM, but T2DM seems to have additional harmful effects and emerging evidence suggests that glycation of collagen may be an important factor. Higher BMD but higher fracture risk presents challenges i...

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Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease

Cited by 160 publications

References 38 publications

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Bone Metabolism and Fracture Risk in Diabetes Mellitus

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

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