scholarly journals Longitudinal Evolution of Bone Microarchitecture and Bone Strength in Type 2 Diabetic Postmenopausal Women With and Without History of Fragility Fractures—A 5-Year Follow-Up Study Using High Resolution Peripheral Quantitative Computed Tomography

2021 ◽  
Vol 12 ◽  
Author(s):  
Ursula Heilmeier ◽  
Gabby B. Joseph ◽  
Courtney Pasco ◽  
Nhan Dinh ◽  
Soheyla Torabi ◽  
...  
Keyword(s):  
Bone Strength ◽  
Bone Disease ◽  
Bone Microarchitecture ◽  
Quantitative Computed Tomography ◽  
Fragility Fractures ◽  
Peripheral Quantitative Computed Tomography ◽  
Cortical Porosity ◽  
History Of ◽  
Type 2 Diabetic

IntroductionDiabetic bone disease is characterized by an increased fracture risk which may be partly attributed to deficits in cortical bone quality such as higher cortical porosity. However, the temporal evolution of bone microarchitecture, strength, and particularly of cortical porosity in diabetic bone disease is still unknown. Here, we aimed to prospectively characterize the 5-year changes in bone microarchitecture, strength, and cortical porosity in type 2 diabetic (T2D) postmenopausal women with (DMFx) and without history of fragility fractures (DM) and to compare those to nondiabetic fracture free controls (Co) using high resolution peripheral quantitative computed tomography (HR-pQCT).MethodsThirty-two women underwent baseline HR-pQCT scanning of the ultradistal tibia and radius and a FU-scan 5 years later. Bone microarchitectural parameters, including cortical porosity, and bone strength estimates via µFEA were calculated for each timepoint and annualized. Linear regression models (adjusted for race and change in BMI) were used to compare the annualized percent changes in microarchitectural parameters between groups.ResultsAt baseline at the tibia, DMFx subjects exhibited the highest porosity of the three groups (66.3% greater Ct.Po, 71.9% higher Ct.Po.Volume than DM subjects, p < 0.022). Longitudinally, porosity increased significantly over time in all three groups and at similar annual rates, while DMFx exhibited the greatest annual decreases in bone strength indices (compared to DM 4.7× and 6.7× greater decreases in failure load [F] and stiffness [K], p < 0.025; compared to Co 14.1× and 22.2× greater decreases in F and K, p < 0.020).ConclusionOur data suggest that despite different baseline levels in cortical porosity, T2D women with and without fractures experienced long-term porosity increases at a rate similar to non-diabetics. However, the annual loss in bone strength was greatest in T2D women with a history of a fragility fractures. This suggests a potentially non-linear course of cortical porosity development in T2D bone disease: major porosity may develop early in the course of disease, followed by a smaller steady annual increase in porosity which in turn can still have a detrimental effect on bone strength—depending on the amount of early cortical pre-damage.

scholarly journals Sex- and Age-Related Differences in Bone Microarchitecture in Men Relative to Women Assessed by High-Resolution Peripheral Quantitative Computed Tomography

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Shreyasee Amin ◽  
Sundeep Khosla
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Bone Strength ◽  
Bone Biopsy ◽  
Bone Microarchitecture ◽  
Quantitative Computed Tomography ◽  
Older Men ◽  
Peripheral Quantitative Computed Tomography ◽  
Men And Women ◽  
Age Related

The trabecular and cortical compartments of bone each contributes to bone strength. Until recently, assessment of trabecular and cortical microstructure has required a bone biopsy. Now, trabecular and cortical microstructure of peripheral bone sites can be determined noninvasively using high-resolution peripheral quantitative computed tomography (HR-pQCT). Studies that have used HR-pQCT to evaluate cohorts of both men and women have provided novel insights into the changes in bone microarchitecture that occur with age between the sexes, which may help to explain the lower fracture incidence in older men relative to women. This review will highlight observations from these studies on both the sex- and age-related differences in trabecular and cortical microstructure that may underlie the differences in bone strength, and thereby fracture risk, between men and women.

scholarly journals Effect of luseogliflozin on bone microarchitecture in elderly patients with type 2 diabetes: Study protocol for a randomized controlled trial using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT)

2019 ◽  
Author(s):  
Ai Haraguchi ◽  
Riyoko Shigeno ◽  
Ichiro Horie ◽  
Shimpei Morimoto ◽  
Ayako Ito ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Elderly Patients ◽  
Fracture Risk ◽  
Bone Metabolism ◽  
Bone Microarchitecture ◽  
Quantitative Computed Tomography ◽  
Sglt2 Inhibitor ◽  
Peripheral Quantitative Computed Tomography ◽  
Sglt2 Inhibitors

Abstract Background Elderly patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fracture independent of their bone mineral density (BMD), which is explained mainly by the deteriorated bone quality in T2DM compared to non-diabetic adults. Sodium-glucose co-transporter (SGLT) 2 inhibitors have been studied in several trials in T2DM, and the Canagliflozin Cardiovascular Assessment Study showed an increased fracture risk related to treatment with the SGLT2 inhibitor canagliflozin, although no evidence of increased fracture risk with treatment with other SGLT2 inhibitors has been reported. The mechanism of the difference in the fracture risk between the SGLT2 inhibitors is unknown, but the differences among the SGLT2 inhibitors in the selectivity of SGLT2 against SGLT1 may affect bone metabolism, since among the SGLT2 inhibitors the selectivity of canagliflozin is lowest. We will investigate whether the SGLT2 inhibitor luseogliflozin, which has higher SGLT2 selectivity, affects bone metabolism by using high-resolution peripheral quantitative computed tomography (HR-pQCT) which provides direct in vivo morphometric information about the bone microarchitecture.Methods This is a single-center, randomized, open-label, active-controlled, parallel pilot trial. Eligible participants are elderly (age ≥60 years) individuals with T2DM with HbA1c levels at 7.0%–8.9%. A total of 24 participants will be allocated to either the luseogliflozin group (taking luseogliflozin) or control group (taking metformin) in a 1:1 ratio to compare the groups' changes in bone microarchitecture of radius and tibia which are analyzed by HR-pQCT before and 48 weeks after the administration of each medication. The laboratory data associated with glycemic control and bone metabolism will be collected every 12 weeks during the study. Recruitment began in June 2019.Discussion The reason we use metformin as an active control is to avoid yielding differences in glycemic control between the luseogliflozin and control groups. Besides, metformin is considered to have neutral effect on bone. This trial will reveal the effect of luseogliflozin on bone metabolism in elderly patients with T2DM.

scholarly journals Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures

2013 ◽  
Vol 28 (2) ◽  
pp. 313-324 ◽  
Author(s):  
Janina M Patsch ◽  
Andrew J Burghardt ◽  
Samuel P Yap ◽  
Thomas Baum ◽  
Ann V Schwartz ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Fragility Fractures ◽  
Cortical Porosity ◽  
Type 2 Diabetic

scholarly journals Effect of luseogliflozin on bone microarchitecture in elderly patients with type 2 diabetes: Study protocol for a randomized controlled pilot trial using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT)

2020 ◽  
Author(s):  
Ai Haraguchi ◽  
Riyoko Shigeno ◽  
Ichiro Horie ◽  
Shimpei Morimoto ◽  
Ayako Ito ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Fracture Risk ◽  
Bone Metabolism ◽  
Bone Microarchitecture ◽  
Pilot Trial ◽  
Quantitative Computed Tomography ◽  
Sglt2 Inhibitor ◽  
Peripheral Quantitative Computed Tomography ◽  
Sglt2 Inhibitors

Abstract Background Elderly patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fracture independent of their bone mineral density (BMD), which is explained mainly by the deteriorated bone quality in T2DM compared to non-diabetic adults. Sodium-glucose co-transporter (SGLT) 2 inhibitors have been studied in several trials in T2DM, and the Canagliflozin Cardiovascular Assessment Study showed an increased fracture risk related to treatment with the SGLT2 inhibitor canagliflozin, although no evidence of increased fracture risk with treatment with other SGLT2 inhibitors has been reported. The mechanism of the difference in the fracture risk between the SGLT2 inhibitors is unknown, but the differences among the SGLT2 inhibitors in the selectivity of SGLT2 against SGLT1 may affect bone metabolism, since among the SGLT2 inhibitors the selectivity of canagliflozin is lowest. We will investigate whether the SGLT2 inhibitor luseogliflozin, which has higher SGLT2 selectivity, affects bone metabolism by using high-resolution peripheral quantitative computed tomography (HR-pQCT) which provides direct in vivo morphometric information about the bone microarchitecture. Methods This is a single-center, randomized, open-label, active-controlled, parallel pilot trial. Eligible participants are elderly (age ≥60 years) individuals with T2DM with HbA1c levels at 7.0%–8.9%. A total of 24 participants will be allocated to either the luseogliflozin group (taking luseogliflozin) or control group (taking metformin) in a 1:1 ratio to compare the groups' changes in bone microarchitecture of radius and tibia which are analyzed by HR-pQCT before and 48 weeks after the administration of each medication. The laboratory data associated with glycemic control and bone metabolism will be collected every 12 weeks during the study. Recruitment began in June 2019. Discussion The reason we use metformin as an active control is to avoid yielding differences in glycemic control between the luseogliflozin and control groups. Besides, metformin is considered to have neutral effect on bone. This trial will reveal the effect of luseogliflozin on bone metabolism in elderly patients with T2DM.

Objectivization of vacuum-compression therapy effects on micro- and macrovascular perfusion in type 2 diabetic patients

2020 ◽  
Vol 65 (4) ◽  
pp. 469-476
Author(s):  
Jaroslav Prucha ◽  
Vladimir Socha ◽  
Lenka Hanakova ◽  
Andrej Lalis ◽  
Karel Hana
Keyword(s):  
Lower Limb ◽  
Compression Therapy ◽  
Neurological Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Therapeutic Procedures ◽  
History Of ◽  
Injury Recovery ◽  
Type 2 Diabetic

AbstractThe present study aimed to evaluate the characteristic influence of physical therapeutic procedures of vacuum-compression therapy (VCT) on microvascular perfusion (MiP) and macrovascular perfusion (MaP) of the lower limb in diabetic patients. A sample of nine patients with a medical history of type 2 diabetes was used for the purpose of this study. Most of the subjects’ medical conditions included venous and neurological complications of the lower limb, whereas the rest of the subjects entered the treatment due to injury recovery or their phlebological disease. The PeriFlux System 5000 (Perimed, Sweden) diagnostic device was used to measure MiP. The MaP was evaluated based on the perfusion index (PI) using the Extremiter monitoring device (Embitron, Czech Republic) designed to perform VCT procedures. The study found that MiP and MaP increase as an effect of VCT procedures and at the same time PI clearly reflects the effect of the applied vacuum and compression phases, verifying the method’s vital influence on peripheral perfusion disorders.

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