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Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes
Type 1 diabetes (T1DM) is associated with an increased fracture risk, specifically at nonvertebral sites. The influence of glycemic control and microvascular disease on skeletal health in long‐standing T1DM remains largely unknown. We aimed to assess areal (aBMD) and volumetric bone mineral density...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons, Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313576/ https://www.ncbi.nlm.nih.gov/pubmed/35094426 http://dx.doi.org/10.1002/jbmr.4517 |
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author | Sewing, Lilian Potasso, Laura Baumann, Sandra Schenk, Denis Gazozcu, Furkan Lippuner, Kurt Kraenzlin, Marius Zysset, Philippe Meier, Christian |
author_facet | Sewing, Lilian Potasso, Laura Baumann, Sandra Schenk, Denis Gazozcu, Furkan Lippuner, Kurt Kraenzlin, Marius Zysset, Philippe Meier, Christian |
author_sort | Sewing, Lilian |
collection | PubMed |
description | Type 1 diabetes (T1DM) is associated with an increased fracture risk, specifically at nonvertebral sites. The influence of glycemic control and microvascular disease on skeletal health in long‐standing T1DM remains largely unknown. We aimed to assess areal (aBMD) and volumetric bone mineral density (vBMD), bone microarchitecture, bone turnover, and estimated bone strength in patients with long‐standing T1DM, defined as disease duration ≥25 years. We recruited 59 patients with T1DM (disease duration 37.7 ± 9.0 years; age 59.9 ± 9.9 years.; body mass index [BMI] 25.5 ± 3.7 kg/m(2); 5‐year median glycated hemoglobin [HbA1c] 7.1% [IQR 6.82–7.40]) and 77 nondiabetic controls. Dual‐energy X‐ray absorptiometry (DXA), high‐resolution peripheral quantitative computed tomography (HRpQCT) at the ultradistal radius and tibia, and biochemical markers of bone turnover were assessed. Group comparisons were performed after adjustment for age, gender, and BMI. Patients with T1DM had lower aBMD at the hip (p < 0.001), distal radius (p = 0.01), lumbar spine (p = 0.04), and femoral neck (p = 0.05) as compared to controls. Cross‐linked C‐telopeptide (CTX), a marker of bone resorption, was significantly lower in T1DM (p = 0.005). At the distal radius there were no significant differences in vBMD and bone microarchitecture between both groups. In contrast, patients with T1DM had lower cortical thickness (estimate [95% confidence interval]: −0.14 [−0.24, −0.05], p < 0.01) and lower cortical vBMD (−28.66 [−54.38, −2.93], p = 0.03) at the ultradistal tibia. Bone strength and bone stiffness at the tibia, determined by homogenized finite element modeling, were significantly reduced in T1DM compared to controls. Both the altered cortical microarchitecture and decreased bone strength and stiffness were dependent on the presence of diabetic peripheral neuropathy. In addition to a reduced aBMD and decreased bone resorption, long‐standing, well‐controlled T1DM is associated with a cortical bone deficit at the ultradistal tibia with reduced bone strength and stiffness. Diabetic neuropathy was found to be a determinant of cortical bone structure and bone strength at the tibia, potentially contributing to the increased nonvertebral fracture risk. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). |
format | Online Article Text |
id | pubmed-9313576 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley & Sons, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93135762022-07-30 Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes Sewing, Lilian Potasso, Laura Baumann, Sandra Schenk, Denis Gazozcu, Furkan Lippuner, Kurt Kraenzlin, Marius Zysset, Philippe Meier, Christian J Bone Miner Res Original Articles Type 1 diabetes (T1DM) is associated with an increased fracture risk, specifically at nonvertebral sites. The influence of glycemic control and microvascular disease on skeletal health in long‐standing T1DM remains largely unknown. We aimed to assess areal (aBMD) and volumetric bone mineral density (vBMD), bone microarchitecture, bone turnover, and estimated bone strength in patients with long‐standing T1DM, defined as disease duration ≥25 years. We recruited 59 patients with T1DM (disease duration 37.7 ± 9.0 years; age 59.9 ± 9.9 years.; body mass index [BMI] 25.5 ± 3.7 kg/m(2); 5‐year median glycated hemoglobin [HbA1c] 7.1% [IQR 6.82–7.40]) and 77 nondiabetic controls. Dual‐energy X‐ray absorptiometry (DXA), high‐resolution peripheral quantitative computed tomography (HRpQCT) at the ultradistal radius and tibia, and biochemical markers of bone turnover were assessed. Group comparisons were performed after adjustment for age, gender, and BMI. Patients with T1DM had lower aBMD at the hip (p < 0.001), distal radius (p = 0.01), lumbar spine (p = 0.04), and femoral neck (p = 0.05) as compared to controls. Cross‐linked C‐telopeptide (CTX), a marker of bone resorption, was significantly lower in T1DM (p = 0.005). At the distal radius there were no significant differences in vBMD and bone microarchitecture between both groups. In contrast, patients with T1DM had lower cortical thickness (estimate [95% confidence interval]: −0.14 [−0.24, −0.05], p < 0.01) and lower cortical vBMD (−28.66 [−54.38, −2.93], p = 0.03) at the ultradistal tibia. Bone strength and bone stiffness at the tibia, determined by homogenized finite element modeling, were significantly reduced in T1DM compared to controls. Both the altered cortical microarchitecture and decreased bone strength and stiffness were dependent on the presence of diabetic peripheral neuropathy. In addition to a reduced aBMD and decreased bone resorption, long‐standing, well‐controlled T1DM is associated with a cortical bone deficit at the ultradistal tibia with reduced bone strength and stiffness. Diabetic neuropathy was found to be a determinant of cortical bone structure and bone strength at the tibia, potentially contributing to the increased nonvertebral fracture risk. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). John Wiley & Sons, Inc. 2022-03-08 2022-05 /pmc/articles/PMC9313576/ /pubmed/35094426 http://dx.doi.org/10.1002/jbmr.4517 Text en © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Sewing, Lilian Potasso, Laura Baumann, Sandra Schenk, Denis Gazozcu, Furkan Lippuner, Kurt Kraenzlin, Marius Zysset, Philippe Meier, Christian Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title | Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title_full | Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title_fullStr | Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title_full_unstemmed | Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title_short | Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes |
title_sort | bone microarchitecture and strength in long‐standing type 1 diabetes |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313576/ https://www.ncbi.nlm.nih.gov/pubmed/35094426 http://dx.doi.org/10.1002/jbmr.4517 |
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