Diabetes-Associated Bone Deterioration Linked to Fracture Risk

Deterioration of the cortical bone and reductions in bone area might be associated with an increased risk for fractures among older patients with type 2 diabetes, according to a recent study.

In their study, the researchers analyzed high resolution peripheral quantitative computed tomography data from 1069 participants involved in the Framingham study. The mean age of participants was 64 years, and 129 (12%) participants had type 2 diabetes. Cortical and trabecular bone microarchitecture, bone mineral density (BMD), bone area, and strength were compared between those with type 2 diabetes and those without diabetes. Secondary analyses were used to evaluate whether associations between diabetes and bone measures differed based on prior fractures, sex, and obesity.
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Overall, participants with diabetes had lower cortical volumetric BMD, higher cortical porosity, and smaller cross-sectional area at the tibia, but not the radius, compared with those without diabetes, after researchers adjusted for age, sex, weight, and height. Additionally, trabecular indices were either similar or more favorable among those with diabetes compared with those without diabetes.

The associations between diabetes and bone measures did differ between individuals with a history of fracture and those with no history of fracture, but did not differ for sex or obesity. Participants with diabetes and a prior fracture had lower cortical volumetric BMD at the tibia and cortical thickness at the radius compared with those without diabetes. Conversely, cortical porosity at the radius was higher among those with diabetes without a history of fractures compared with those without diabetes

“Findings from this large, community-based study of older adults suggest that modest deterioration in cortical bone and reductions in bone area may characterize diabetic bone disease in older adults,” the researchers concluded. “Evaluation of these deficits as predictors of fracture in [type 2 diabetes] is needed to develop prevention strategies in this rapidly increasing population of older adults.”

—Melissa Weiss

Reference:

Samelson EJ, Demissie S, Cupples LA, et al. Diabetes and deficits in cortical bone density, microarchitecture, and bone size: Framingham HR-pQCT Study [published online September 20, 2017]. J Bone Miner Res. doi:10.1002/jbmr.3240.