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Defects in cortical microarchitecture among African-American women with type 2 diabetes

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Abstract

Summary

Patients with type 2 diabetes mellitus (DM2) have increased fracture risk. We found that African-American women with DM2 have increased cortical porosity and lower cortical bone density at the radius than non-diabetic controls. These cortical deficits are associated with hyperglycemia and may contribute to skeletal fragility associated with DM2.

Introduction

Fracture risk is increased in patients with type 2 diabetes mellitus (DM2) despite normal areal bone mineral density (aBMD). DM2 is more common in African-Americans than in Caucasians. It is not known whether African-American women with DM2 have deficits in bone microstructure.

Methods

We measured aBMD at the spine and hip by DXA, and volumetric BMD (vBMD) and microarchitecture at the distal radius and tibia by HR-pQCT in 22 DM2 and 78 non-diabetic African-American women participating in the Study of Women Across the Nation (SWAN). We also measured fasting glucose and HOMA-IR.

Results

Age, weight, and aBMD at all sites were similar in both groups. At the radius, cortical porosity was 26 % greater, while cortical vBMD and tissue mineral density were lower in women with DM2 than in controls. There were no differences in radius total vBMD or trabecular vBMD between groups. Despite inferior cortical bone properties at the radius, FEA-estimated failure load was similar between groups. Tibia vBMD and microarchitecture were also similar between groups. There were no significant associations between cortical parameters and duration of DM2 or HOMA-IR. However, among women with DM2, higher fasting glucose levels were associated with lower cortical vBMD (r = −0.54, p = 0.018).

Conclusions

DM2 and higher fasting glucose are associated with unfavorable cortical bone microarchitecture at the distal radius in African-American women. These structural deficits may contribute to the increased fracture risk among women with DM2. Further, our results suggest that hyperglycemia may be involved in mechanisms of skeletal fragility associated with DM2.

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References

  1. Behavioral Risk Factor Surveillance System 2010. Centers for Disease Control and Prevention. Department of Health and Human Services. http://phstwlp2.partners.org:2692/brfss/ Accessed 16 Apr 2014

  2. Tuominen JT, Impivaara O, Puukka P, Ronnemaa T (1999) Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 22:1196–1200

    Article  CAS  PubMed  Google Scholar 

  3. Strotmeyer ES, Cauley JA, Schwartz AV et al (2004) Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the health, aging, and body composition study. J Bone Miner Res 19:1084–1091

    Article  PubMed  Google Scholar 

  4. Ivers RQ, Cumming RG, Mitchell P, Peduto AJ, Blue Mountains Eye S (2001) Diabetes and risk of fracture: the blue mountains eye study. Diabetes Care 24:1198–1203

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, Johnson KC, Margolis KL (2006) Risk of fracture in women with type 2 diabetes: the women’s health initiative observational study. J Clin Endocrinol Metab 91:3404–3410

    Article  CAS  PubMed  Google Scholar 

  7. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR, Study of Osteoporotic Features Research G (2001) Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 86:32–38

    Article  CAS  PubMed  Google Scholar 

  8. Vashishth D (2007) The role of the collagen matrix in skeletal fragility. Curr Osteoporos Rep 5:62–66

    Article  PubMed  Google Scholar 

  9. Burghardt AJ, Issever AS, Schwartz AV, Davis KA, Masharani U, Majumdar S, Link TM (2010) High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 95:5045–5055

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Patsch JM, Burghardt AJ, Yap SP, Baum T, Schwartz AV, Joseph GB, Link TM (2013) Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures. J Bone Miner Res 28:313–324

    Article  PubMed Central  PubMed  Google Scholar 

  11. Putman MS, Yu EW, Lee H, Neer RM, Schindler E, Taylor AP, Cheston E, Bouxsein ML, Finkelstein JS (2013) Differences in skeletal microarchitecture and strength in African-American and Caucasian women. J Bone Miner Res 28:2177–2185

    Article  PubMed Central  PubMed  Google Scholar 

  12. Baecke JA, Burema J, Frijters JE (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942

    CAS  PubMed  Google Scholar 

  13. Santoro N, Torrens J, Crawford S et al (2005) Correlates of circulating androgens in mid-life women: the study of women’s health across the nation. J Clin Endocrinol Metab 90:4836–4845

    Article  CAS  PubMed  Google Scholar 

  14. Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27:1487–1495

    Article  PubMed  Google Scholar 

  15. Burghardt AJ, Buie HR, Laib A, Majumdar S, Boyd SK (2010) Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone 47:519–528

    Article  PubMed Central  PubMed  Google Scholar 

  16. Boutroy S, Van Rietbergen B, Sornay-Rendu E, Munoz F, Bouxsein M, Delmas P (2008) Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J Bone Miner Res 23:392–399

    Article  PubMed  Google Scholar 

  17. Shu A, Yin MT, Stein E, Cremers S, Dworakowski E, Ives R, Rubin MR (2012) Bone structure and turnover in type 2 diabetes mellitus. Osteoporos Int 23:635–641

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Farr JN, Drake MT, Amin S, Melton LJ 3rd, McCready LK, Khosla S (2014) In vivo assessment of bone quality in postmenopausal women with type 2 diabetes. J Bone Miner Res 29:787–795

    Article  PubMed  Google Scholar 

  19. Pritchard JM, Giangregorio LM, Atkinson SA, Beattie KA, Inglis D, Ioannidis G, Punthakee Z, Adachi JD, Papaioannou A (2012) 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 64:83–91

    Article  Google Scholar 

  20. Leslie WD, Aubry-Rozier B, Lamy O, Hans D, Manitoba Bone Density P (2013) TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab 98:602–609

    Article  CAS  PubMed  Google Scholar 

  21. Dhaliwal R, Cibula D, Ghosh C, Weinstock RS, Moses AM (2014) Bone quality assessment in type 2 diabetes mellitus. Osteoporos Int (Epub ahead of print)

  22. Wang X-F, Wang Q, Ghasem-Zadeh A, Evans A, Mcleod C, Iuliano-Burns S, Seeman E (2009) Differences in macro- and microarchitecture of the appendicular skeleton in young Chinese and white women. J Bone Miner Res 24:1946–1952

    Article  PubMed  Google Scholar 

  23. Walker MD, Mcmahon DJ, Udesky J, Liu G, Bilezikian JP (2009) Application of high-resolution skeletal imaging to measurements of volumetric BMD and skeletal microarchitecture in Chinese-American and white women: explanation of a paradox. J Bone Miner Res 24:1953–1959

    Article  PubMed Central  PubMed  Google Scholar 

  24. Schwartz AV (2006) Diabetes, TZDs, and bone: a review of the clinical evidence. PPAR Res 2006:24502

    Article  PubMed Central  PubMed  Google Scholar 

  25. Leslie WD, Rubin MR, Schwartz AV, Kanis JA (2012) Type 2 diabetes and bone. J Bone Miner Res 27:2231–2237

    Article  PubMed  Google Scholar 

  26. Zebaze R, Ghasem-Zadeh A, Mbala A, Seeman E (2013) A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone 54:8–20

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). We would like to thank the Massachusetts General Hospital (MGH) Bone Density Center and the MGH HR-pQCT Core Facility, which is supported by NIH grant 1S10RR023405. EWY was also supported by NIH grant DK093713. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.

Conflicts of interest

None.

NIH grant:

1S10RR023405; K23 DK093713; U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495.

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Authors and Affiliations

  1. Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA, 02114, USA

    E. W. Yu, M. S. Putman, N. Derrico, G. Abrishamanian-Garcia, J. S. Finkelstein & M. L. Bouxsein

  2. Endocrine Division, Children’s Hospital Boston, Boston, MA, 02115, USA

    M. S. Putman

Authors
  1. E. W. Yu
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  2. M. S. Putman
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  3. N. Derrico
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  4. G. Abrishamanian-Garcia
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  5. J. S. Finkelstein
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  6. M. L. Bouxsein
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Correspondence to E. W. Yu.

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Yu, E.W., Putman, M.S., Derrico, N. et al. Defects in cortical microarchitecture among African-American women with type 2 diabetes. Osteoporos Int 26, 673–679 (2015). https://doi.org/10.1007/s00198-014-2927-7

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  • DOI: https://doi.org/10.1007/s00198-014-2927-7

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