Matthias Walle1, Danielle E Whittier1, Morten Frost2, Ralph Müller1, Caitlyn J Collins3,4. 1. Institute for Biomechanics, ETH Zurich, Zurich, Switzerland. 2. Molecular Endocrinology Laboratory & Steno Diabetes Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark. 3. Institute for Biomechanics, ETH Zurich, Zurich, Switzerland. caitlyn.collins@hest.ethz.ch. 4. Department of Biomedical Engineering and Mechanics, Virginia Tech, 323 Kelly Hall, 325 Stanger Street, Blacksburg, 24061, VA, USA. caitlyn.collins@hest.ethz.ch.
Abstract
PURPOSE OF REVIEW: Diabetes mellitus is defined by elevated blood glucose levels caused by changes in glucose metabolism and, according to its pathogenesis, is classified into type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Diabetes mellitus is associated with multiple degenerative processes, including structural alterations of the bone and increased fracture risk. High-resolution peripheral computed tomography (HR-pQCT) is a clinically applicable, volumetric imaging technique that unveils bone microarchitecture in vivo. Numerous studies have used HR-pQCT to assess volumetric bone mineral density and microarchitecture in patients with diabetes, including characteristics of trabecular (e.g. number, thickness and separation) and cortical bone (e.g. thickness and porosity). However, study results are heterogeneous given different imaging regions and diverse patient cohorts. RECENT FINDINGS: This meta-analysis assessed T1DM- and T2DM-associated characteristics of bone microarchitecture measured in human populations in vivo reported in PubMed- and Embase-listed publications from inception (2005) to November 2021. The final dataset contained twelve studies with 516 participants with T2DM and 3067 controls and four studies with 227 participants with T1DM and 405 controls. While T1DM was associated with adverse trabecular characteristics, T2DM was primarily associated with adverse cortical characteristics. These adverse effects were more severe at the radius than the load-bearing tibia, indicating increased mechanical loading may compensate for deleterious bone microarchitecture changes and supporting mechanoregulation of bone fragility in diabetes mellitus. Our meta-analysis revealed distinct predilection sites of bone structure aberrations in T1DM and T2DM, which provide a foundation for the development of animal models of skeletal fragility in diabetes and may explain the uncertainty of predicting bone fragility in diabetic patients using current clinical algorithms.
PURPOSE OF REVIEW: Diabetes mellitus is defined by elevated blood glucose levels caused by changes in glucose metabolism and, according to its pathogenesis, is classified into type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Diabetes mellitus is associated with multiple degenerative processes, including structural alterations of the bone and increased fracture risk. High-resolution peripheral computed tomography (HR-pQCT) is a clinically applicable, volumetric imaging technique that unveils bone microarchitecture in vivo. Numerous studies have used HR-pQCT to assess volumetric bone mineral density and microarchitecture in patients with diabetes, including characteristics of trabecular (e.g. number, thickness and separation) and cortical bone (e.g. thickness and porosity). However, study results are heterogeneous given different imaging regions and diverse patient cohorts. RECENT FINDINGS: This meta-analysis assessed T1DM- and T2DM-associated characteristics of bone microarchitecture measured in human populations in vivo reported in PubMed- and Embase-listed publications from inception (2005) to November 2021. The final dataset contained twelve studies with 516 participants with T2DM and 3067 controls and four studies with 227 participants with T1DM and 405 controls. While T1DM was associated with adverse trabecular characteristics, T2DM was primarily associated with adverse cortical characteristics. These adverse effects were more severe at the radius than the load-bearing tibia, indicating increased mechanical loading may compensate for deleterious bone microarchitecture changes and supporting mechanoregulation of bone fragility in diabetes mellitus. Our meta-analysis revealed distinct predilection sites of bone structure aberrations in T1DM and T2DM, which provide a foundation for the development of animal models of skeletal fragility in diabetes and may explain the uncertainty of predicting bone fragility in diabetic patients using current clinical algorithms.
Authors: E W Yu; M S Putman; N Derrico; G Abrishamanian-Garcia; J S Finkelstein; M L Bouxsein Journal: Osteoporos Int Date: 2014-11-15 Impact factor: 4.507
Authors: Lora M Giangregorio; William D Leslie; Lisa M Lix; Helena Johansson; Anders Oden; Eugene McCloskey; John A Kanis Journal: J Bone Miner Res Date: 2012-02 Impact factor: 6.741
Authors: L-A Fraser; L Langsetmo; C Berger; G Ioannidis; D Goltzman; J D Adachi; A Papaioannou; R Josse; C S Kovacs; W P Olszynski; T Towheed; D A Hanley; S M Kaiser; J Prior; S Jamal; N Kreiger; J P Brown; H Johansson; A Oden; E McCloskey; J A Kanis; W D Leslie Journal: Osteoporos Int Date: 2010-12-16 Impact factor: 4.507
Authors: Andrew J Burghardt; Ahi S Issever; Ann V Schwartz; Kevin A Davis; Umesh Masharani; Sharmila Majumdar; Thomas M Link Journal: J Clin Endocrinol Metab Date: 2010-08-18 Impact factor: 5.958
Authors: Karen L Troy; Megan E Mancuso; Joshua E Johnson; Zheyang Wu; Thomas J Schnitzer; Tiffiny A Butler Journal: J Bone Miner Res Date: 2020-03-30 Impact factor: 6.390