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Bone Microarchitecture in Men and Women with Diabetes: The Importance of Cortical Porosity

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Abstract

High-resolution peripheral quantitative computed tomography (HR-pQCT) captures novel aspects of bone geometry, volumetric bone mineral density and offers the ability to measure bone microarchitecture, but data relating measures obtained from this technique to diabetic status are inconsistent in women and lacking in men. Here, we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between bone microarchitecture from HR-pQCT of distal radius and distal tibia in 332 participants (177 men and 155 women) aged 72.1–81.4 years with or without diabetes mellitus (DM); n = 29 (18 men and 11 women) and n = 303, respectively. Statistical analyses were performed separately for women and men. The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5) years in women and men, respectively. Participants with DM differed significantly in terms of weight in both women (70.4 ± 12.3 vs. 80.3 ± 18.3 kg; p = 0.015) and men (81.7 ± 11.4 vs. 92.8 ± 16.3 kg; p < 0.001) but no differences were found in height, smoking status, alcohol intake, social class and physical activity among women or men. Analyses in women revealed that cortical pore volume (Ct.Po.V) was higher in participants with DM and close to statistical significance for cortical porosity (Ct.Po) (β = 0.76 [0.12, 1.41] z-score, p = 0.020 and β = 0.62 [−0.02, 1.27] z-score, p = 0.059, respectively) at the distal radius. Adjustment for weight did not materially affect the relationship described for Ct.Po.V (β = 0.74 [0.09, 1.39], p = 0.027) and Ct.Po (β = 0.65 [−0.01, 1.30], p = 0.053) at the distal radius. After adjustment for weight, analyses in men revealed that Ct.Po and Ct.Po.V were higher in participants with DM (β = 0.57 [0.09, 1.06] z-score, p = 0.021 and β = 0.48 [0.01, 0.95] z-score, p = 0.044, respectively) at the distal tibia. Analyses of distal radial and tibial trabecular bone parameters according to diabetic status revealed no significant differences among men or women after adjustment for weight. We found higher cortical porosity and cortical pore volume at the distal tibia in men with DM and higher cortical pore volume at the distal radius in women with a non-significant tendency for higher cortical porosity. The results of our study suggest that deficits in cortical bone exist both in older men and women with DM.

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References

  1. Schwartz AV, Sellmeyer DE, Ensrud KE et al (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 

  2. Melton LJ, Leibson CL, Achenbach SJ, Therneau TM, Khosla S (2008) Fracture risk in type 2 diabetes: update of a population-based study. J Bone Miner Res 23:1334–1342

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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 

  4. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444

    Article  CAS  PubMed  Google Scholar 

  5. Schwartz AV, Vittinghoff E, Bauer DC et al (2011) Association of BMD, FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 305:2184–2192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 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  PubMed Central  Google Scholar 

  7. 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  PubMed Central  Google Scholar 

  8. Patsch JM, Burghardt AJ, Yap SP et al (2013) Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures. J Bone Miner Res 28:313–324

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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  PubMed Central  Google Scholar 

  10. Syddall HE, Aihie SA, Dennison EM, Martin HJ, Barker DJ, Cooper C (2005) Cohort profile: the Hertfordshire cohort study. Int J Epidemiol 34:1234–1242

    Article  CAS  PubMed  Google Scholar 

  11. Declaration of Helsinki (2009) Ethical principles for medical research involving human subjects. J Indian Med Assoc 107:403–405

    Google Scholar 

  12. Boutroy S, Bouxsein ML, Munoz F, Delmas PD (2005) In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 90:6508–6515

    Article  CAS  PubMed  Google Scholar 

  13. Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S (2012) Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone 50:111–118

    Article  CAS  PubMed  Google Scholar 

  14. Laib A, Hauselmann HJ, Ruegsegger P (1998) In vivo high resolution 3D-QCT of the human forearm. Technol Health Care 6(5–6):329–337

    CAS  PubMed  Google Scholar 

  15. Khosla S, Riggs BL, Atkinson EJ et al (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based non-invasive in vivo assessment. J Bone Miner Res 21:124–131

    Article  PubMed  PubMed Central  Google Scholar 

  16. MacNeil JA, Boyd SK (2007) Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys 29:1096–1105

    Article  PubMed  Google Scholar 

  17. Burghardt AJ, Kazakia GJ, Ramachandran S, Link TM, Majumbar S (2010) Age- and gender-related differences in the geometric properties and biomechanical significance of intracortical porosity in the distal radius and tibia. J Bone Miner Res 25:983–993

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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  PubMed Central  Google Scholar 

  19. Paggiosi MA, Eastell R, Walsh JS (2014) Precision of high-resolution peripheral quantitative computed tomography measurement variables: influence of gender, examination site, and age. Calcif Tissue Int 94:191–201

    Article  CAS  PubMed  Google Scholar 

  20. Samelson EJ, Bouxsein M, Brochin E et al (2014) Deficits in cortical bone density and microstructure in type 2 diabetes: Framingham HR-pQCT study. J Bone Miner Res 29(Suppl 1). http://www.asbmr.org/Meetings. Accessed 14 Sept 2014

  21. Heilmeier U, Cheng K, Parrish R et al (2014) Cortical bone laminar analysis reveals increased midcortical porosity in type 2 diabetics with history of fragility fractures. J Bone Miner Res 29(Suppl 1). http://www.asbmr.org/Meetings. Accessed 14 Sept 2014

  22. Yu EW, Putman MS, Derrico N, Abrishamanian-Garcia G, Finkelstein JS, Bouxsein ML (2015) Defects in cortical microarchitecture among African-American women with type 2 diabetes. Osteoporos Int 26:673–679

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Fink D, Furst J, Zhang C et al (2014) Bone properties in type 2 diabetes are associated with the advanced glycation end product pentosidine. J Bone Miner Res 29(Suppl 1). http://www.asbmr.org/Meetings. Accessed 12 Sept 2014

  24. Yamagishi SI (2011) Role of advanced glycation end products (AGEs) in osteoporosis in diabetes. Curr Drug Targets 12:2096–2102

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research has been made possible thanks to a fellowship grant from Arthritis Research UK (Grant Number 19583). The present work was funded by grants from servier and la Société Française de Rhumatologie. This research is funded by MRC (Programme Number U105960371).The Hertfordshire Cohort Study was supported by the Medical Research Council (MRC) of Great Britain; Arthritis Research UK; and the International Osteoporosis Foundation. The work herein was also supported by the NIHR Nutrition BRC, University of Southampton and the NIHR Musculoskeletal BRU, University of Oxford. KAW’s research is funded by MRC Programme number U105960371. Imaging was performed at MRC Human Nutrition Research, Cambridge. We thank all of the men and women who took part in the Hertfordshire Cohort Study; the HCS Research Staff; and Vanessa Cox who managed the data.

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Correspondence to Cyrus Cooper.

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Professor Cooper has received consultancy fees/honoraria from Servier; Eli Lilly; Merck; Amgen; Alliance; Novartis; Medtronic; GSK; Roche. Julien Paccou, Mark Edwards, Kate Ward, Karen Jameson, Charlotte Moss, Nicholas Harvey, and Elaine Dennison declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article contains studies with human subjects and all participants gave written informed consent in accordance with the Declaration of Helsinki. This studies did not include animals.

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Paccou, J., Ward, K.A., Jameson, K.A. et al. Bone Microarchitecture in Men and Women with Diabetes: The Importance of Cortical Porosity. Calcif Tissue Int 98, 465–473 (2016). https://doi.org/10.1007/s00223-015-0100-8

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  • DOI: https://doi.org/10.1007/s00223-015-0100-8

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