Microstructural and Strength Changes in Trabecular Bone in Elderly Patients with Type 2 Diabetes Mellitus

Giner, Mercè; Miranda, Cristina; Vázquez-Gámez, MA; Altea-Manzano, Patricia; Miranda, M. J.; Casado-Díaz, Antonio; Pérez‐Cano, Ramón; Montoya-García, María-José

doi:10.3390/diagnostics11030577

Cited by 9 publications

(6 citation statements)

References 35 publications

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“…A trabecular bone is a large-surface bone widely exposed to blood flow and bone marrow that is differentially influenced by several biochemical factors, including hormones and drugs, and with a higher turnover compared to dense cortical bone [ 7 ]. For these reasons, the metabolic imbalance can easily lead to its microarchitectural deterioration and worsening of mechanical properties [ 62 , 63 ]. TBS, determined from lumbar spine DXA images, reflects qualitative aspects of the skeletal structure, providing an indirect index of trabecular microarchitecture that is partially independent of, but complementary to, BMD [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

et al. 2022

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Sirtuin1 (SIRT1) and sclerostin play important roles in adipose tissue and bone metabolism. We evaluated the circulating SIRT1 and sclerostin relationship with mass and quality of bone while considering the degree of adiposity. Sixty-six premenopausal women (16 underweight, 25 normal weight and 25 with obesity), aged <50 years, were enrolled. Plasma SIRT1, sclerostin and DXA body composition (total fat mass (FM), abdominal visceral adipose tissue, lean mass, trabecular bone score (TBS) and lumbar spine and femoral neck (FN) bone mineral density (BMD)) were assessed. The patients with obesity showed the lowest SIRT1 and TBS values and the highest sclerostin concentrations; BMD increased with FM and BMI and had an inverse association with SIRT1. Sclerostin was negatively correlated with SIRT1 (ρ = −0.37, p = 0.002). When spine BMD, FN BMD and TBS were standardized for BMI, a positive correlation with SIRT1 and a negative correlation with sclerostin were seen (p < 0.005). In the regression analysis, sclerostin was the best independent, negative predictor for BMD and TBS, while SIRT1 directly predicted TBS (p < 0.05). In conclusion, blood measurement of SIRT1 and sclerostin could represent a snapshot of the bone status that, taking into account the degree of adiposity, may reduce the interference of confounding factors in the interpretation of bone health parameters.

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Section: Discussionmentioning

confidence: 99%

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

et al. 2022

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“…Previous studies have shown that the evolution of fractures describes the existence of complications in the consolidation period related to smoking or age ( 37 ) although, loss of bone minerals or diabetes highly influence the process. The most recent evidence ( 18 , 20 , 22 , 38 ) have pointed out that the bone tissue of diabetic patients presents loss of collagen ( 21 ), a high percentage of AGE advanced glycation products and a worse quality of trabecular bone which could compromise, in addition, its mechanical properties ( 20 , 39 ). Our results showed that bone consolidation time was similar between diabetic and non-diabetic patients (see Table 1 ), achieving a solid and effective consolidation in both groups.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have described deleterious effects of diabetic hyperglycemia on bone tissue quality ( 17 ), for example fragility or energy absorption ( 18 ), changes in trabecular volume and thickness ( 19 ) as well as mechanical properties ( 20 ) in addition to variants in the properties of collagen, minerals, and AGEs (advanced glycation products) ( 20 , 21 ). The accumulation of these diabetic exposure changes in bone cell activity could impair consolidation and long-term progenitor cell potential and may create vascular deficiencies at the fracture site ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of bone consolidation chronology in claw toes operated through minimal invasive osteotomies in diabetic vs. non-diabetic patients

et al. 2022

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ObjectiveTo compare bone healing time in osteotomies performed in claw toes correction through minimal invasive surgery in diabetic vs. non-diabetic patients. The relation between the patient's ages and the American Orthopedic Foot and Ankle Surgery Society (AOFAS) functional scores before and after surgery was also analyze in the two types of patients.MethodA series of 45 women, 23 of them suffering from Diabetes Mellitus, were operated to correct claw toes. The surgery was always performed through minimal invasive digital osteotomies. After the intervention, bone healing was controlled by a fluoroscopic weekly follow-up until a complete bone consolidation was reached. Bone healing time was compared in in two groups of patients, diabetic and non-diabetic. All patients were evaluated with AOFAS scale 48 h before and 90 days after the intervention.ResultsThe time of bone healing ranged from 24 to 40 days after the surgery and took shorter time of consolidation in non-diabetic patients although the Mann Withney U test did not show statistically significant differences (p = 0,409, effect size (ES) = 0,14 [-0.20 to 0.45]) between both groups. A statistically significant association (r = 0.71, R2 = 50%, p < 0.001) was found between the healing days and the day of medical discharge, also between the ages of the patients and the medial discharge (r = 0.36, R2 = 13%, p < 0.001). However, no statistically significant associations were found between pre-intervention glycemia and days of bone consolidation, neither in medical discharge (r = 0.07, p = 0.646 y r = 0.07, p = 0.648, respectively). AOFAS test scores and the diabetes status showed statistically significant differences, both in the main effect of Diabetes (F[1,41] = 9.41, p = 0.004) as in the interaction between diabetes and age (F[1,41] = 9.17, p = 0.004).ConclusionsThe bone healing time in claw toes operated through minimal invasive osteotomy surgery is not influenced by the presence of diabetes. The consolidation speed and the improvement in AOFAS functional scale score post-surgery in diabetic and elder patients was related to duration of the medical discharge.

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“…Furthermore, post-hip fracture mortality is higher in T2DM patients, with an increased risk of death up to 44% in the first year after the event ( 3 ). While the contribution of T2DM to low bone density is still debated, it is recognized that the longer the disease duration, the higher the trabecular bone microarchitecture and mechanical properties damage ( 4 ). Moreover, the combination of both T2DM-related intrinsic (i.e., vision impairment and loss of balance due to neuropathy and retinopathy complications) and extrinsic factors (for example, treatment-induced hypoglycemia), confers to the diabetic older patient an increased likelihood of falls, which are well-known to be associated with poor outcomes in advanced age ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

et al. 2021

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BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.

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Microstructural and Strength Changes in Trabecular Bone in Elderly Patients with Type 2 Diabetes Mellitus

Cited by 9 publications

References 35 publications

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

Comparative analysis of bone consolidation chronology in claw toes operated through minimal invasive osteotomies in diabetic vs. non-diabetic patients

Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

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