Larger Trabecular Holes Explain Bone Fragility in Diabetes

More porous bone may up fracture risk despite normal bone density in postmenopausal women

MONDAY, Jan. 9 (HealthDay News) -- The higher fracture risk observed in women with type 2 diabetes mellitus (T2DM) may be due, in part, to the larger average hole size and, consequently, the more porous nature of their trabecular bone microarchitecture, according to a study published in the January issue of Arthritis Care & Research.

Janet M. Pritchard, of McMaster University in Hamilton, Canada, and colleagues used magnetic resonance imaging to compare the trabecular bone microarchitecture of the distal radius in 60 postmenopausal women (mean age, 71 years): 30 with T2DM and 30 without diabetes. Results were adjusted for a variety of potential confounders, including percent body fat, ethnicity, age-adjusted Charlson Index, calcium and vitamin D intake, and a timed up-and-go test to assess physical mobility. Areal bone mineral density (aBMD) at the lumbar spine and proximal femur were assessed using dual X-ray absorptiometry.

The researchers found that women with T2DM had 13.3 percent larger holes within the trabecular bone network than women without T2DM. In addition, aBMD at the lumbar spine was elevated in women with T2DM; after adjustment for body mass index, aBMD at the lumbar spine was similar between the groups.

"Given the known contribution of bone microarchitecture to overall bone strength, these findings may explain why an elevated fracture risk has been observed in women with type 2 DM despite normal or elevated aBMD. Future research should clarify the independent contribution of DM to fracture risk, to inform risk assessment and stratification, and should focus on understanding other mechanisms behind diabetic bone fragility," the authors write.

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