Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures

• Published in: Journal of bone and mineral research 2013-02, Vol.28 (2), p.313-324
• Main Authors: Patsch, Janina M, Burghardt, Andrew J, Yap, Samuel P, Baum, Thomas, Schwartz, Ann V, Joseph, Gabby B, Link, Thomas M
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Age; Biomechanical Phenomena; Bone (cortical); Bone Density; Bone mineral density; Bone strength; Computed tomography; CORTICAL POROSITY; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Dual energy X-ray absorptiometry; Female; Fractures; Fractures, Bone - complications; Fractures, Bone - diagnostic imaging; Fractures, Bone - physiopathology; FRAGILITY FRACTURES; HIGH‐RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY; Humans; MICRO‐FINITE ELEMENT ANALYSIS; Middle Aged; Porosity; Post-menopause; Postmenopause - physiology; Radius; Radius - diagnostic imaging; Radius - physiopathology; Tibia; Tibia - diagnostic imaging; Tibia - physiopathology; Tomography, X-Ray Computed; TYPE 2 DIABETES MELLITUS
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1002/jbmr.1763

The primary goal of this study was to assess peripheral bone microarchitecture and strength in postmenopausal women with type 2 diabetes with fragility fractures (DMFx) and to compare them with postmenopausal women with type 2 diabetics without fractures (DM). Secondary goals were to assess differences in nondiabetic postmenopausal women with fragility fractures (Fx) and nondiabetic postmenopausal women without fragility fractures (Co), and in DM and Co women. Eighty women (mean age 61.3 ± 5.7 years) were recruited into these four groups (DMFx, DM, Fx, and Co; n = 20 per group). Participants underwent dual‐energy X‐ray absorptiometry (DXA) and high‐resolution peripheral quantitative computed tomography (HR‐pQCT) of the ultradistal and distal radius and tibia. In the HR‐pQCT images volumetric bone mineral density and cortical and trabecular structure measures, including cortical porosity, were calculated. Bone strength was estimated using micro–finite element analysis (µFEA). Differential strength estimates were obtained with and without open cortical pores. At the ultradistal and distal tibia, DMFx had greater intracortical pore volume (+52.6%, p = 0.009; +95.4%, p = 0.020), relative porosity (+58.1%, p = 0.005; +87.9%, p = 0.011) and endocortical bone surface (+10.9%, p = 0.031; +11.5%, p = 0.019) than DM. At the distal radius DMFx had 4.7‐fold greater relative porosity (p