High-Resolution Peripheral Quantitative Computed Tomographic Imaging of Cortical and Trabecular Bone Microarchitecture in Patients with Type 2 Diabetes Mellitus

Burghardt, Andrew J.; Issever, Ahi Sema; Schwartz, Ann V.; Davis, Kevin; Masharani, Umesh; Majumdar, Sharmila; Link, Thomas M.

doi:10.1210/jc.2010-0226

Cited by 436 publications

(372 citation statements)

References 63 publications

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“…The authors also reported no difference in indices of bone strength between groups, which might be attributed to the sample size in this study. While variables of trabecular bone microarchitecture and indices of bone strength at the radius were not found to be different in this previous pQCT study, Burghardt and colleagues did report a greater number of cortical pores and greater cortical bone pore volume at the radius (47). Similar findings have been reported in men with type 2 DM (48).…”

Section: Pritchard Et Alsupporting

confidence: 76%

“…Moreover, some suggest that comprehensive imaging studies aiming to determine histomorphometric differences between groups should have at least 50 participants per group to provide sufficient power (19). Burghardt and colleagues also found no differences in radius microarchitectural indices, including Tb.N, in a smaller pilot study in women with type 2 DM and age-and height-matched healthy controls using pQCT (47). The authors also reported no difference in indices of bone strength between groups, which might be attributed to the sample size in this study.…”

Section: Pritchard Et Almentioning

confidence: 52%

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Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

Pritchard¹,

Giangregorio²,

Atkinson³

et al. 2011

Arthritis Care & Research

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Objective. Adults with type 2 diabetes mellitus (DM) have an elevated fracture risk despite normal areal bone mineral density (aBMD). The study objective was to compare trabecular bone microarchitecture of postmenopausal women with type 2 DM and women without type 2 DM.Methods. An extremity 1T magnetic resonance imaging system was used to acquire axial images (195 ؋ 195 ؋ 1,000 m 3 voxel size) of the distal radius of women recruited from outpatient clinics or by community advertisement. Image segmentation yielded geometric, topologic, and stereologic outcomes, i.e., number and size of trabecular bone network holes (marrow spaces), endosteal area, trabecular bone volume fraction, nodal and branch density, and apparent trabecular thickness, separation, and number. Lumbar spine (LS) and proximal femur BMD were measured with dual x-ray absorptiometry. Microarchitectural differences were assessed using linear regression and adjusted for percent body fat, ethnicity, timed up-and-go test, Charlson Index, and calcium and vitamin D intake; aBMD differences were adjusted for body mass index (BMI). Results. Women with type 2 DM (n ‫؍‬ 30, mean ؎ SD age 71.0 ؎ 4.8 years) had larger holes (؉13.3%; P ‫؍‬ 0.001) within the trabecular bone network than women without type 2 DM (n ‫؍‬ 30, mean ؎ SD age 70.7 ؎ 4.9 years). LS aBMD was greater in women with type 2 DM; however, after adjustment for BMI, LS aBMD did not differ between groups. Conclusion. In women with type 2 DM, the average hole size within the trabecular bone network at the distal radius is greater compared to controls. This may explain the elevated fracture risk in this population.

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Section: Pritchard Et Alsupporting

confidence: 76%

Section: Pritchard Et Almentioning

confidence: 52%

Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

Pritchard¹,

Giangregorio²,

Atkinson³

et al. 2011

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…The reasons for the increased risk for fracture in T2DM patients are not clear [6,10]. Increased cortical porosity of distal radius or distal tibia has been invoked as one possible factor [11][12][13]. However, it is hard to explain how individuals with T2DM can exhibit high porosity [14][15][16][17], since increased cortical porosity reflects increased bone turnover from intracortical surfaces lining the Haversian canals and the endocortical surfaces adjacent to the marrow cavity [18,19].…”

Section: Introductionmentioning

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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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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“…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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High-Resolution Peripheral Quantitative Computed Tomographic Imaging of Cortical and Trabecular Bone Microarchitecture in Patients with Type 2 Diabetes Mellitus

Cited by 436 publications

References 63 publications

Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

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

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

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