Investigation of Mechanical, Material, and Compositional Determinants of Human Trabecular Bone Quality in Type 2 Diabetes

2021 ◽  
Author(s):  
Praveer Sihota ◽  
Ram Naresh Yadav ◽  
Ruban Dhaliwal ◽  
Jagadeesh Chandra Bose ◽  
Vandana Dhiman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Trabecular Bone ◽  
Bone Tissue ◽  
Energy Absorption ◽  
Bone Quality ◽  
Fragility Fracture ◽  
Bone Fragility ◽  
Diabetic Group ◽  
Trabecular Bone Quality

Abstract Context Increased bone fragility and reduced energy absorption to fracture associated with type 2 diabetes (T2D) cannot be explained by bone mineral density alone. This study, for the first time, reports on alterations in bone tissue’s material properties obtained from individuals with diabetes and known fragility fracture status. Objective To investigate the role of T2D in altering biomechanical, microstructural, and compositional properties of bone in individuals with fragility fracture. Methods Femoral head bone tissue specimens were collected from patients who underwent replacement surgery for fragility hip fracture. Trabecular bone quality parameters were compared in samples of 2 groups, nondiabetic (n = 40) and diabetic (n = 30), with a mean duration of disease 7.5 ± 2.8 years. Results No significant difference was observed in aBMD between the groups. Bone volume fraction (BV/TV) was lower in the diabetic group due to fewer and thinner trabeculae. The apparent-level toughness and postyield energy were lower in those with diabetes. Tissue-level (nanoindentation) modulus and hardness were lower in this group. Compositional differences in the diabetic group included lower mineral:matrix, wider mineral crystals, and bone collagen modifications—higher total fluorescent advanced glycation end-products (fAGEs), higher nonenzymatic cross-link ratio (NE-xLR), and altered secondary structure (amide bands). There was a strong inverse correlation between NE-xLR and postyield strain, fAGEs and postyield energy, and fAGEs and toughness. Conclusion The current study is novel in examining bone tissue in T2D following first hip fragility fracture. Our findings provide evidence of hyperglycemia’s detrimental effects on trabecular bone quality at multiple scales leading to lower energy absorption and toughness indicative of increased propensity to bone fragility.

Assessment of bone quality with trabecular bone score in type 2 diabetes mellitus: A study from the FRISBEE cohort

2019 ◽  
Vol 73 (5) ◽  
pp. e13347 ◽  
Author(s):  
Felicia Baleanu ◽  
Pierre Bergmann ◽  
Anne Sophie Hambye ◽  
Carole Dekelver ◽  
Laura Iconaru ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Trabecular Bone ◽  
Bone Quality ◽  
Trabecular Bone Score

scholarly journals Fragility fractures and bone remodeling in type 2 diabetes mellitus

2017 ◽  
Vol 14 (3) ◽  
pp. 11-18 ◽  
Author(s):  
Tatiana O. Yalochkina ◽  
Zhanna E. Belaya
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Type 2 Diabetes ◽  
Bone Tissue ◽  
Bone Mineral ◽  
Bone Fragility ◽  
Mineral Density ◽  
Severe Diabetes ◽  
Increased Risk

Fracture risk is significantly increased in both type 1 and type 2 diabetes and individuals with diabetes experience worse fracture outcomes compared to normoglycemic individuals. Patients with T1DM have decreased bone mineral density (BMD), whereas patients with T2DM demonstrate increased BMD compared to healthy control. The latest studies show increased incidence of low-traumatic fractures in patients with T2DM instead of high bone mineral density (BMD). The risk of osteoporotic fractures in patients with T2DM can be explained by disease complications and increased risk of falls and consequent trauma. However, the most important cause of bone fragility in T2DM is the deterioration in bone microarchitecture, the mechanism of which is not completely understood. High BMD in patients with T2DM does not allow us to use dual-energy X-ray-absorptiometry as a gold standard test for diagnosticsof osteoporosis. Consequently,new risk factors and diagnostic algorithm as well as treatment strategy should be developed for patients with T2DM. In addition to this, some researchers considered that the group of T2DM is geterogenous and physicians might face patients with osteoporosis and mild diabetes that add very little to bone fragility; patients with osteoporosis and moderate or severe diabetes which also affects bone tissue diabetoosteoporosis; and patients without osteoporosis but severe diabetes which cause bone tissue deterioration with the development of diabetic bone disease. New diagnostic tools and algorithm and new experimental research are needed for better understanding bone deterioration in patients with T2DM. This review summarizes our current knowledge on fracture rate, risk factors for fractures and causes of bone deterioration in subjects with T2DM.

scholarly journals Good Long-Term Glycemic Compensation Is Associated With Better Trabecular Bone Score in Postmenopausal Women With Type 2 Diabetes

2019 ◽  
pp. S149-S156
Author(s):  
P. JACKULIAK ◽  
M. KUŽMA ◽  
Z. KILLINGER ◽  
J. PAYER
Keyword(s):  
Type 2 Diabetes ◽  
Bone Density ◽  
Glycemic Control ◽  
Trabecular Bone ◽  
Postmenopausal Women ◽  
Bone Quality ◽  
Glycated Hemoglobin ◽  
Trabecular Bone Score ◽  
Osteoporotic Fractures

Osteoporosis is an increasingly widespread disease, as well as diabetes mellitus. It is now accepted that osteoporotic fractures are a serious co-morbidity and complication of diabetes. Despite of good bone mineral density in Type 2 Diabetes (T2DM) patients is the fracture risk elevated. It is due to reduced bone quality. To determine the effect of glycemic compensation on bone density and trabecular bone score (TBS) in T2DM. We analyzed a cohort of 105 postmenopausal women with T2DM. For all patients, central bone density (spinal and lumbar spine) was tested by DXA methodology, glycemic control parameters were assessed, and anthropometric parameters were measured. Bone quality was analyzed using TBS software. The results were statistically processed. Good glycemic compensation with glycated hemoglobin (A1c) value <7.0 % DCCT did not lead to BMD changes in patients with T2DM. However, patients with HbA1c <7 % DCCT had significantly better TBS (1.254±0.148 vs. 1.166±0.094, p=0.01). There was a negative correlation between TBS and glycated hemoglobin (r= -0,112, p<0.05) with glycemic fasting (r= -0.117, p<0.05). The optimal effect on TBS is achieved when all three markers of glycemic compensation (glycated hemoglobin, fasting plasma glucose and postprandial glycemia) are in optimal range. By using ROC curves glycated hemoglobin has the most significant effect on TBS. Optimal glycemic compensation, evaluated by glycated hemoglobin, does not lead to changes in BMD but has a beneficial effect on TBS in T2DM. Good glycemic control is required also for reduction of the risk of osteoporosis and osteoporotic fractures.

scholarly journals Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

2020 ◽  
Vol 2020 ◽  
pp. 1-18 ◽  
Author(s):  
C. Eller-Vainicher ◽  
E. Cairoli ◽  
G. Grassi ◽  
F. Grassi ◽  
A. Catalano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fracture Risk ◽  
Bone Quality ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
Pathophysiological Mechanisms ◽  
Increased Risk

Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of bone fragility fractures compared to nondiabetic subjects. This increased fracture risk may occur despite normal or even increased values of bone mineral density (BMD), and poor bone quality is suggested to contribute to skeletal fragility in this population. These concepts explain why the only evaluation of BMD could not be considered an adequate tool for evaluating the risk of fracture in the individual T2DM patient. Unfortunately, nowadays, the bone quality could not be reliably evaluated in the routine clinical practice. On the other hand, getting further insight on the pathogenesis of T2DM-related bone fragility could consent to ameliorate both the detection of the patients at risk for fracture and their appropriate treatment. The pathophysiological mechanisms underlying the increased risk of fragility fractures in a T2DM population are complex. Indeed, in T2DM, bone health is negatively affected by several factors, such as inflammatory cytokines, muscle-derived hormones, incretins, hydrogen sulfide (H2S) production and cortisol secretion, peripheral activation, and sensitivity. All these factors may alter bone formation and resorption, collagen formation, and bone marrow adiposity, ultimately leading to reduced bone strength. Additional factors such as hypoglycemia and the consequent increased propensity for falls and the direct effects on bone and mineral metabolism of certain antidiabetic medications may contribute to the increased fracture risk in this population. The purpose of this review is to summarize the literature evidence that faces the pathophysiological mechanisms underlying bone fragility in T2DM patients.

Trabecular bone score and insulin resistance in type 2 diabetes mellitus

2020 ◽  
Author(s):  
Ponce Maria Hayon ◽  
Laguna Mª del Carmen Serrano ◽  
Perez Maria Dolores Aviles ◽  
Beatriz Garcia Fontana ◽  
Sheila Gonzalez Salvatierra ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Trabecular Bone ◽  
Trabecular Bone Score

1983-P: WNT Pathway and Bone Fragility in Postmenopausal Women with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1983-P
Author(s):  
ALESSANDRA PICCOLI ◽  
FRANCESCA CANNATA ◽  
FABRIZIO RUSSO ◽  
VALENTINA L. GRETO ◽  
CAMILLA ISGRÒ ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Postmenopausal Women ◽  
Wnt Pathway ◽  
Bone Fragility

Trabecular Bone Score in Thais with or without Type 2 Diabetes

2020 ◽  
Vol 103 (11) ◽  
pp. 1131-1137
Keyword(s):  
Diabetes Mellitus ◽  
Bone Mineral Density ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Mineral Density ◽  
Men And Women

Background: When compared to people without type 2 diabetes mellitus (T2DM), people with T2DM have an increase in fracture risk despite having higher bone mineral density (BMD). Many studies in Caucasians demonstrated that trabecular bone score (TBS) is lower in people with T2DM than those without. The utility of TBS as a fracture risk assessment tool in Asians with T2DM is currently unclear. Objective: To compared lumbar spine (LS) BMD and TBS in Thais with or without T2DM and investigate the correlation between TBS and hemoglobin A1c (HbA1c) and diabetes duration in participants with T2DM. Materials and Methods: The present study was a cross-sectional study that included 97 participants with T2DM (37 men and 60 women) and 342 participants without T2DM (174 men and 168 women). LS-BMD and TBS were obtained. Results: Men and women with T2DM were older and had higher body mass index (BMI). Men with T2DM had significant higher LS-BMD (1.051±0.166 versus 0.972±0.125, p=0.009) and non-significant lower TBS (1.333±0.084 versus 1.365±0.096, p=0.055) than those without. Similarly, women with T2DM had significant higher LS-BMD (0.995±0.155 versus 0.949±0.124, p=0.021) and lower TBS (1.292±0.105 versus 1.382±0.096, p<0.001). After adjusting for age and BMI, T2DM predicted higher BMD in men (p<0.001), but not in women (p=0.143). T2DM was not associated with TBS after adjusting for age and BMI in both genders (p=0.403 and p=0.151 in men and women, respectively). TBS did not correlate with HbA1c in both genders. However, TBS was non-significantly associated with diabetes duration in women (p=0.073), but not in men (p=0.639). Conclusion: T2DM significantly predicted higher LS-BMD only in men and was not independently associated with TBS in both genders. These data highlighted that, in T2DM, there was some variation in the clinical usefulness of BMD and TBS in predicting osteoporotic fractures with regard to clinical characteristic of participants. Keywords: Bone mineral density, Type 2 diabetes mellitus, Trabecular bone score

Type 2 diabetes and bone fragility- An under-recognized association

2021 ◽  
Vol 15 (3) ◽  
pp. 927-935
Author(s):  
Khalid J. Farooqui ◽  
Ambrish Mithal ◽  
Ann Kwee Kerwen ◽  
Manju Chandran
Keyword(s):  
Type 2 Diabetes ◽  
Bone Fragility
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