Similarities in trabecular hypertrophy with site-specific differences in cortical morphology between men and women with type 2 diabetes mellitus

Abstract

The goal of our study was to investigate interactions between sex and type 2 diabetes mellitus (T2DM) with regard to morphology of the peripheral skeleton. We recruited 85 subjects (mean age, 57±11.4 years): women with and without T2DM (n = 17; n = 16); and men with and without T2DM (n = 26; n = 26). All patients underwent high-resolution, peripheral, quantitative, computed tomography (HR-pQCT) imaging of the ultradistal radius (UR) and tibia (UT). Local bone geometry, bone mineral density (BMD), and bone microarchitecture were obtained by quantitative analysis of HR-pQCT images. To reduce the amount of data and avoid multi-collinearity, we performed a factor-analysis of HR-pQCT parameters. Based on factor weight, trabecular BMD, trabecular number, cortical thickness, cortical BMD, and total area were chosen for post-hoc analyses. At the radius and tibia, diabetic men and women exhibited trabecular hypertrophy, with a significant positive main effect of T2DM on trabecular number. At the radius, cortical thickness was higher in diabetic subjects (+20.1%, p = 0.003). Interestingly, there was a statistical trend that suggested attenuation of tibial cortical hypertrophy in diabetic men (cortical thickness, pinteraction = 0.052). Moreover, we found an expected sexual dichotomy, with higher trabecular BMD, Tb.N, cortical BMD, Ct.Th, and total area in men than in women (p≤ 0.003) at both measurement sites. Our results suggest that skeletal hypertrophy associated with T2DM is present in men and women, but appears attenuated at the tibial cortex in men.

Robust Trabecular Microstructure in Type 2 Diabetes Revealed by Individual Trabecula Segmentation Analysis of HR-pQCT Images

“…Despite consistent findings on cortical bone, data on trabecular bone structure are contradictory. Using HR‐pQCT, we and others have found that trabecular microarchitecture is preserved in T2D patients . However, in studies using MRI, postmenopausal women with T2D were found to have larger holes within the trabecular network at the distal radius than nondiabetic women .…”

“…Conflicting data exist regarding trabecular bone quality in T2D. In prior studies using standard HR‐pQCT measures, trabecular microarchitecture has been shown to be preserved in T2D . The scant existing histomorphometry data show no alterations in trabecular bone indices in T2D .…”

“…In prior studies using standard HR-pQCT measures, trabecular microarchitecture has been shown to be preserved in T2D. (12)(13)(14)18,19,40) The scant existing histomorphometry data show no alterations in trabecular bone indices in T2D. (42) However, studies employing other tools suggest that it may be impaired.…”

“…Using HR-pQCT, we and others have found that trabecular microarchitecture is preserved in T2D patients. (12–14,18,19) However, in studies using MRI, postmenopausal women with T2D were found to have larger holes within the trabecular network at the distal radius than nondiabetic women. (20) Moreover, trabecular bone score (TBS), a technique that uses spine DXA images to perform a gray-level textural analysis of trabecular bone microarchitecture, was abnormal in T2D and predictive of fractures in a number of reports.…”

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“…A study comparing men and women with and without T2DM reported that T2DM was associated with skeletal hypertrophy (measured using HRpQCT), which was attenuated at the tibial cortex in men compared to women [143].…”