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Diabetes related to low bone material strength
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Women with type 2 diabetes often have lower bone material strength and poorer physical function compared with women without diabetes, study data show.
Anna G. Nilsson, MD, PhD, senior consultant in endocrinology and internal medicine at Sahlgrenska University Hospital and director of studies at the Centre for Bone and Arthritis Research at the University of Gothenburg in Sweden, and colleagues evaluated data from the Swedish national population register 2013-2016 on 99 women with type 2 diabetes (mean age, 77.6 years) and 954 women without diabetes (controls; mean age, 77.7 years) to characterize bone phenotype in type 2 diabetes.
DXA was used to measure areal bone mineral density and high-resolution peripheral quantitative CT was used to measure bone microarchitecture.
Participants with type 2 diabetes had higher areal BMD compared with controls, but no differences existed after adjustment for covariates.
Compared with controls, participants with type 2 diabetes had higher trabecular bone volume fraction of the radius and tibia (P < .001 for both).
Participants with type 2 diabetes had lower bone mineral strength index (P .001) and significantly higher stiffness and failure load compared with controls.
Physical function test results were poorer in participants with type 2 diabetes compared with controls for the one leg standing test (P < .001), chair-stand test (P < .05) walking speed (P < .001) and time up and go test (P < .01).
“Despite normal BMD and better bone microarchitecture, older women with type 2 diabetes have reduced bone material strength,” Nilsson told Endocrine Today. “This, in combination with poorer physical function may contribute to the increased risk for bone fractures that has been described in type 2 diabetes. The clinical implication is that the fracture risk in type 2 daibetes cannot be estimated from measurement of BMD alone.” – by Amber Cox
For more information:
Anna G. Nilsson, MD, PhD, can be reached at anna.nilsson@medic.gu.se.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Mone Zaidi
This study should not be misinterpreted in terms of type 2 diabetes causing better bone. Bone strength, which has declined in the women under study, is a composite of bone density and microarchitecture, but also is determined by the composition of bone. It is unclear how composition of bone — notably parameters such as crystal size, collagen-crosslinks, phosphorylation status of proteins or advanced glycosylation end product (AGE) accumulation — changes with type 2 diabetes; all of these are known to decrease bone strength and, hence, its propensity to fracture. Interestingly, type 2 diabetes-associated fractures occur at somewhat unusual sites. Reduced physical function, including gait abnormalities not specifically measured in this study, together with poor quality of bone even in the presence of adequate quantity measured by DXA and microarchitecture measured by high-resolution peripheral quantitative CT, can cause a high fracture risk.
Disclosure: Zaidi reports financial ties with Amgen, Merck, Roche and Shire Pharmaceuticals.
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