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Imaging of Diabetic Bone Structure

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Diabetic Bone Disease

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Abstract

Epidemiological studies have found that patients with type 2 diabetes mellitus (T2DM) have a higher incidence of fragility fractures despite normal or elevated bone mineral density (BMD) measured with DXA. Studies have shown that bone structure and composition independent of BMD may explain the increased risk of fragility fractures in T2DM. High-resolution quantitative computed tomography (HR-pQCT) is a new technology to investigate bone quality analyzing cortical and trabecular bone structure. Using HR-pQCT differences in cortical porosity at the distal radius and tibia between T2DM patients with and without fragility fractures have been found. It has been suggested that cortical porosity may serve as a new imaging biomarker for increased fragility in T2DM. In addition, abnormalities of bone marrow fat using MR spectroscopy of the spine were demonstrated in T2DM patients: vertebral bone marrow fat content correlated significantly with HbA1c and visceral adipose tissue in T2DM patients and decreased unsaturated bone marrow lipids were found to be associated with T2DM and fragility fractures. Other imaging technologies that have been used to assess bone structure and texture in diabetic bone disease are high-resolution MRI, quantitative ultrasound, and trabecular bone score derived from DXA images. This chapter will summarize results from recent studies analyzing bone structure and quality in patients with diabetic bone disease and increased fracture risk.

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References

  1. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495–505. PubMed Epub 2007/06/19. eng.

    Article  PubMed  Google Scholar 

  2. Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res. 2009;24:702–9. PubMed Epub 2008/12/04.Eng.

    Article  CAS  PubMed  Google Scholar 

  3. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab. 2001;86(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  4. Bone health and osteoporosis: a report of the Surgeon General. Rockville: Office of the Surgeon General; 2004.

    Google Scholar 

  5. Melton III LJ, Riggs BL, Leibson CL, Achenbach SJ, Camp JJ, Bouxsein ML, et al. A bone structural basis for fracture risk in diabetes. J Clin Endocrinol Metab. 2008;93(12):4804–9. PubMed Epub 2008/09/18. eng.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Vestergaard P, Rejnmark L, Mosekilde L. Diabetes and its complications and their relationship with risk of fractures in type 1 and 2 diabetes. Calcif Tissue Int. 2009;84(1):45–55. PubMed Epub 2008/12/11. eng.

    Article  CAS  PubMed  Google Scholar 

  7. Schwartz AV, Sellmeyer DE. Diabetes, fracture, and bone fragility. Curr Osteoporos Rep. 2007;5(3):105–11. PubMed Epub 2007/10/11. eng.

    Article  PubMed  Google Scholar 

  8. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25(10):1749–54.

    Article  PubMed  Google Scholar 

  9. Burghardt AJ, Issever AS, Schwartz AV, Davis KA, Masharani U, Majumdar S, et al. High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab. 2010;95(11):5045–55. Pubmed Central PMCID: 2968722. Epub 2010/08/20. eng.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Patsch JM, Burghardt AJ, Yap SP, Baum T, Schwartz AV, Joseph GB, et al. Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures. J Bone Miner Res. 2013;28(2):313–24. Pubmed Central PMCID: 3534818.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Patsch JM, Li X, Baum T, Yap SP, Karampinos DC, Schwartz AV, et al. Bone marrow fat composition as a novel imaging biomarker in postmenopausal women with prevalent fragility fractures. J Bone Miner Res. 2013;28(8):1721–8. Pubmed Central PMCID: 3720702.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Pritchard JM, Giangregorio LM, Atkinson SA, Beattie KA, Inglis D, Ioannidis G, et al. Changes in trabecular bone microarchitecture in postmenopausal women with and without type 2 diabetes: a two year longitudinal study. BMC Musculoskelet Disord. 2013;14:114. Pubmed Central PMCID: 3618189.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Pritchard JM, Giangregorio LM, Atkinson SA, Beattie KA, Inglis D, Ioannidis G, et al. Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls. Arthritis Care Res. 2012;64(1):83–91.

    Article  Google Scholar 

  14. Yamaguchi T, Yamamoto M, Kanazawa I, Yamauchi M, Yano S, Tanaka N, et al. Quantitative ultrasound and vertebral fractures in patients with type 2 diabetes. J Bone Miner Metab. 2011;29(5):626–32.

    Article  PubMed  Google Scholar 

  15. Dhaliwal R, Cibula D, Ghosh C, Weinstock RS, Moses AM. Bone quality assessment in type 2 diabetes mellitus. Osteoporos Int. 2014;25(7):1969–73.

    Article  CAS  PubMed  Google Scholar 

  16. Leslie WD, Aubry-Rozier B, Lamy O, Hans D, Manitoba Bone Density Program. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab. 2013;98(2):602–9.

    Article  CAS  PubMed  Google Scholar 

  17. Burghardt AJ, Buie HR, Laib A, Majumdar S, Boyd SK. Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone. 2010;47(3):519–28. Pubmed Central PMCID: 2926164. Epub 2010/06/22. eng.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Damilakis J, Adams JE, Guglielmi G, Link TM. Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol. 2010;20(11):2707–14. Pubmed Central PMCID: 2948153.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Shu A, Yin MT, Stein E, Cremers S, Dworakowski E, Ives R, et al. Bone structure and turnover in type 2 diabetes mellitus. Osteoporos Int. 2012;23(2):635–41. Pubmed Central PMCID: 3690650.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Li X, Kuo D, Schafer AL, Porzig A, Link TM, Black D, et al. Quantification of vertebral bone marrow fat content using 3 Tesla MR spectroscopy: reproducibility, vertebral variation, and applications in osteoporosis. J Magn Reson Imaging. 2011;33(4):974–9. Pubmed Central PMCID: 3072841. Epub 2011/03/31. eng.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Li X, Shet K, Rodriguez JP, Pino AM, Kurhanewicz J, Schwartz A, et al. Unsaturation level decreased in bone marrow lipids of postmenopausal women with low bone density using high resolution HRMAS NMR. ASBMR 2012, Minneapolis, MN; 12–15 Oct 2012.

    Google Scholar 

  22. Baum T, Yap SP, Karampinos DC, Nardo L, Kuo D, Burghardt AJ, et al. Does vertebral bone marrow fat content correlate with abdominal adipose tissue, lumbar spine BMD and blood biomarkers in women with type 2 diabetes mellitus? J Magn Reson Imaging. 2012;35(1):117–24.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Wehrli FW, Gomberg BR, Saha PK, Song HK, Hwang SN, Snyder PJ. Digital topological analysis of in vivo magnetic resonance microimages of trabecular bone reveals structural implications of osteoporosis. J Bone Miner Res. 2001;16(8):1520–31.

    Article  CAS  PubMed  Google Scholar 

  24. Wehrli FW, Leonard MB, Saha PK, Gomberg BR. Quantitative high-resolution magnetic resonance imaging reveals structural implications of renal osteodystrophy on trabecular and cortical bone. J Magn Reson Imaging. 2004;20(1):83–9.

    Article  PubMed  Google Scholar 

  25. Krug R, Burghardt AJ, Majumdar S, Link TM. High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am. 2010;48(3):601–21. Pubmed Central PMCID: 2901255.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Krug R, Carballido-Gamio J, Banerjee S, Burghardt AJ, Link TM, Majumdar S. In vivo ultra-high-field magnetic resonance imaging of trabecular bone microarchitecture at 7 T. J Magn Reson Imaging. 2008;27(4):854–9. PubMed Epub 2008/04/03. eng.

    Article  PubMed  Google Scholar 

  27. Parrish R, Rivoire J, Han M, Schafer AV, Link TM, Krug R, et al., editors. Multi-modality in vivo imaging identifies marrow and vasculature within pathological cortical porosity. ASBMR, Houston; 2014.

    Google Scholar 

  28. Guglielmi G, Adams J, Link TM. Quantitative ultrasound in the assessment of skeletal status. Eur Radiol. 2009;19(8):1837–48.

    Article  PubMed  Google Scholar 

  29. Gluer CC, Eastell R, Reid DM, Felsenberg D, Roux C, Barkmann R, et al. Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS Study. J Bone Miner Res. 2004;19(5):782–93.

    Article  PubMed  Google Scholar 

  30. Gonnelli S, Cepollaro C, Gennari L, Montagnani A, Caffarelli C, Merlotti D, et al. Quantitative ultrasound and dual-energy X-ray absorptiometry in the prediction of fragility fracture in men. Osteoporos Int. 2005;16(8):963–8.

    Article  PubMed  Google Scholar 

  31. Gonnelli S, Cepollaro C, Montagnani A, Martini S, Gennari L, Mangeri M, et al. Heel ultrasonography in monitoring alendronate therapy: a four-year longitudinal study. Osteoporos Int. 2002;13(5):415–21.

    Article  CAS  PubMed  Google Scholar 

  32. Patel S, Hyer S, Tweed K, Kerry S, Allan K, Rodin A, et al. Risk factors for fractures and falls in older women with type 2 diabetes mellitus. Calcif Tissue Int. 2008;82(2):87–91.

    Article  CAS  PubMed  Google Scholar 

  33. Bousson V, Bergot C, Sutter B, Levitz P, Cortet B, Scientific Committee of the Groupe de Recherche et d’Information sur les Ostéoporoses. Trabecular bone score (TBS): available knowledge, clinical relevance, and future prospects. Osteoporos Int. 2012;23(5):1489–501.

    Article  CAS  PubMed  Google Scholar 

  34. Link TM. Screening: Assessing bone structure in the prediction of osteoporotic fractures. Nat Rev Rheumatol. 2012;8(1):6–8.

    Article  Google Scholar 

  35. Hans D, Goertzen AL, Krieg MA, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res. 2011;26(11):2762–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 550, 16th Street, San Francisco, CA, 94158, USA

    Thomas M. Link M.D., Ph.D. & Ursula Heilmeier M.D.

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  1. Thomas M. Link M.D., Ph.D.
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  2. Ursula Heilmeier M.D.
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Corresponding author

Correspondence to Thomas M. Link M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Departments of Orthopedic Surgery, Physiology and Pharmacology, Center for Diabetes and Endocrine Research; University of Toledo, Toledo, Ohio, USA

    Beata Lecka-Czernik

  2. Departments of Pediatrics, Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA

    John L. Fowlkes

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© 2016 Springer International Publishing Switzerland

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Link, T.M., Heilmeier, U. (2016). Imaging of Diabetic Bone Structure. In: Lecka-Czernik, B., Fowlkes, J. (eds) Diabetic Bone Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-16402-1_11

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  • DOI: https://doi.org/10.1007/978-3-319-16402-1_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16401-4

  • Online ISBN: 978-3-319-16402-1

  • eBook Packages: MedicineMedicine (R0)

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