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. 2021 Mar 23;11(3):577.
doi: 10.3390/diagnostics11030577.

Microstructural and Strength Changes in Trabecular Bone in Elderly Patients with Type 2 Diabetes Mellitus

Mercè Giner  1   2 , Cristina Miranda  2 , María Angeles Vázquez-Gámez  2   3 , Patricia Altea-Manzano  3 , María-José Miranda  2 , Antonio Casado-Díaz  4 , Ramón Pérez-Cano  2   3 , María-José Montoya-García  2   3
Affiliations

Microstructural and Strength Changes in Trabecular Bone in Elderly Patients with Type 2 Diabetes Mellitus

Mercè Giner et al. Diagnostics (Basel). .

Abstract

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide and it is associated with an increased risk of osteoporosis and fragility fractures. Our aim is to analyze the effect of T2DM on bone quality. This is a case-control study. The studied population consisted of 140 patients: 54 subjects with hip fracture (OP) without T2DM, 36 patients with hip fracture and T2DM (OP-T2DM), 28 patients with osteoarthritis (OA) without T2DM, and 22 patients with OA and T2DM (OA-T2DM). Bone markers, bone mineral density, FRAX score, microstructural, and bone material strength from femoral heads were assessed. The group with hip fracture presented lower BMD values than OA (p < 0.05). The OP, OP-T2DM, and OA-T2DM groups showed a decrease in bone volume fraction (BV/TV), in trabecular number (Tb.N), and in trabecular thickness (Tb.Th), while an increase was presented in the structural model index (SMI) and trabecular bone pattern factor (Tb.Pf), The groups OP, OP-T2DM, and OA-T2DM also presented lower values than those in group OA regarding the biomechanical parameters in the form of Young's modulus or elastic modulus, toughness, ultimate stress, ultimate load, extrinsic stiffness, and work to failure (p < 0.05). Our results show the negative effect of type 2 diabetes mellitus on trabecular bone structure and mechanical properties.

Keywords: diagnostic; fracture; hip; imaging; osteoporosis; trauma; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Outline of patient selection and study groups. OP, osteoporotic; OA, osteoarthritis; T2DM, type 2 diabetes mellitus.
Figure 2
Figure 2
Three-dimensional reconstruction and micro-CT images of bone trabecular from femoral heads in the four groups. Two different samples from: (A) OA group; (B) OA-T2DM; (C) OP; (D) OP-T2DM.
Figure 3
Figure 3
Comparisons of structural parameters between patients with OA and OP with or without T2DM. (A) BV/TV, bone volume fraction; (B) Tb.Th, trabecular thickness; (C) Tb.N, trabecular number; (D) SMI, structural model index; (E) Tb.Sp, trabecular separation; (F) Tb.Pf, trabecular bone pattern factor; Values are expressed as the means ± SEM. * p < 0.05, ** p < 0.01, statistically significant.
Figure 4
Figure 4
Comparisons of biomechanical parameters between patients with OA and OP.(A) E, Young’s modulus or elastic modulus; (B) σult, ultimate stress; (C) u, toughness; (D) U, work to failure; (E) Fult, ultimate load; (F) S, extrinsic stiffness. Values are expressed as the means ± SEM. * p < 0.05, ** p < 0.01, and *** p < 0.001 statistically significant.
See this image and copyright information in PMC

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