Abstract
Type 1 diabetes mellitus (DM1) is linked to a decrease in bone strength. Bone strength entails both bone mineral density and bone quality. Limited data are available regarding diabetes-induced microdamage, which can severely influence bone quality. This study has investigated bone microdamage as a measure of bone quality in an animal model of DM1. Microdamage in the neck of the femur was labelled in vivo using multiple fluorochromes at 4, 12 and 24 weeks after the onset of DM1. Microcracks were quantified and their morphology analyzed using microscopy techniques. The mean length of microcracks at 24 weeks, and crack numerical and surface densities were significantly higher (p < 0.05) 4 weeks after the onset of DM1 when compared with control. Diffuse damage density was highest at 12 weeks after the onset of DM1. The arrangement of the collagen fibrils became progressively more irregular from 4 to 24 weeks of DM. This is the first study to analyze microdamage in vivo at different time points of DM1. DM1is associated with microcracks from the early stage, however bone microstructure shows toughening mechanisms that arrest their growth but disease progression further deteriorates bone quality resulting in longer microcracks which may increase fracture risk.
Highlights
Diabetes mellitus (DM) is regarded as one of today’s most pressing health care challenges adversely affecting multiple organs in the body with increasing morbidity and mortality rates globally
The higher fracture incidence in DM1 patients with respect to the general population is due to an increased tendency to falls as a result of its complications such as peripheral neuropathy, poor vision and stroke and and due to early osteoporotic changes resulting in increased bone loss and/or altered bone matrix and strength[2,3]
Type 1 DM predisposes to increased fracture risk which cannot be explained alone by the decrease in bone mineral density, changes in bone quality play a significant role in skeletal fragility associated with diabetes
Summary
Diabetes mellitus (DM) is regarded as one of today’s most pressing health care challenges adversely affecting multiple organs in the body with increasing morbidity and mortality rates globally. Osteoporosis is a disease characterized by abnormalities in the amount (bone quantity) and in architectural arrangement of bone tissue (bone quality) that leads to impaired skeletal strength and undue susceptibility to fractures[6]. It is a silent disease as there are no warning signs until one experiences a fracture after a minor fall, which otherwise in a healthy adult would not have led to a fracture[7]. Most of the studies in the past have linked type I DM with osteoporotic changes by defining only bone quantity but the measurement of bone quantity alone does not always reliably predict fracture risk[3]. This has stimulated us to investigate aspects other than bone quantity that contribute to bone fragility
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