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

Mercè Giner,Antonio Casado-Díaz,Ramón Pérez-Cano,Patricia Altea-Manzano,María-José Montoya-García,María-José Miranda,María Angeles Vázquez-Gámez,Cristina Miranda

doi:10.3390/diagnostics11030577

Abstract

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide and it is associated with an increased risk of osteoporosis and fragility fractures. Our aim is to analyze the effect of T2DM on bone quality. This is a case-control study. The studied population consisted of 140 patients: 54 subjects with hip fracture (OP) without T2DM, 36 patients with hip fracture and T2DM (OP-T2DM), 28 patients with osteoarthritis (OA) without T2DM, and 22 patients with OA and T2DM (OA-T2DM). Bone markers, bone mineral density, FRAX score, microstructural, and bone material strength from femoral heads were assessed. The group with hip fracture presented lower BMD values than OA (p < 0.05). The OP, OP-T2DM, and OA-T2DM groups showed a decrease in bone volume fraction (BV/TV), in trabecular number (Tb.N), and in trabecular thickness (Tb.Th), while an increase was presented in the structural model index (SMI) and trabecular bone pattern factor (Tb.Pf), The groups OP, OP-T2DM, and OA-T2DM also presented lower values than those in group OA regarding the biomechanical parameters in the form of Young’s modulus or elastic modulus, toughness, ultimate stress, ultimate load, extrinsic stiffness, and work to failure (p < 0.05). Our results show the negative effect of type 2 diabetes mellitus on trabecular bone structure and mechanical properties.

Highlights

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide
In order to ascertain whether type 2 diabetes mellitus has a related effect on bone fragility and risk of fracture, we compared the microstructural and biomechanical parameters of osteoporotic patients (OP) either with type 2 diabetes mellitus (OP-T2DM group) or without T2DM (OP group), both with recent fragility fractures, and we compared the OA and OA and T2DM (OA-T2DM) group patients
These results showed that the OA-T2DM patients had similar microstructural characteristics to those of the OP and OP-T2DM patients regarding trabecular bone characteristics, which indicated that the diabetic dise8asoef 1m3 aintains bone mineral density (BMD), but the microarchitecture is of poor quality and more fragile

Summary

Introduction

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide. T2DM patients exhibit an increased risk of suffering further complications of the disease, which are mainly due to complex and interconnected mechanisms, such as hyperglycaemia, insulin-resistance, low-grade inflammation, and accelerated atherogenesis [1]. These chronic complications adversely affect multiple organ systems including that of bones, which were widely associated with an increased risk of osteoporosis and fragility fractures [2,3]. Osteoporosis (OP) is a metabolic bone disease that is characterized by low bone mineral density (BMD) and microarchitectural deterioration in the bone structure, with a higher risk of fragility fractures [4]. BMD values are usually normal or elevated in OA patients at any age, in contrast to OP [6]

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