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Samad N, Nguyen HH, Aleksova J, Pasco JA, Kotowicz MA, Ebeling PR, Vincent AJ, Zebaze R, Milat F. Femora of women with premature ovarian insufficiency exhibit reduced strength and misalignment with the transmitted vertical forces from the upper body. Eur J Endocrinol 2024; 190:182-191. [PMID: 38064575 DOI: 10.1093/ejendo/lvad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Women with premature ovarian insufficiency (POI) lack oestrogen, which is a key determinant of bone growth, epiphyseal closure, and bone tissue organisation. Although dual-energy X-ray absorptiometry (DXA)-derived areal bone mineral density (BMD) remains the gold standard for fracture risk evaluation, it does not fully characterise the skeletal abnormalities present in these women. Hence, we aimed to assess hip/femur anatomy, strength, and geometry and femoral alignment using advanced hip analysis (AHA). METHODS We conducted a cross-sectional, case-control study including 89 women with spontaneous normal karyotype POI (s-POI) or iatrogenic POI (i-POI), aged 20-50 years compared with 89 age- and body mass index (BMI)-matched population-based female controls. Hip anatomy, strength, geometrical parameters, and femur alignment were measured using hip DXA images and Lunar AHA software. Femoral orientation angle (FOA) was quantified as the overall orientation of the femur with respect to the axis of the forces transmitted from the upper body. RESULTS The median age of POI diagnosis was 35 (18-40) years; the mean POI duration at the time of DXA was 2.07 (range 0-13) years, and 84% of POI women received oestrogen therapy. Areal BMD at all sites was significantly lower in the POI group (all P < .05). Indices of compressive and bending strength were lower in women with POI compared with controls, specifically the cross-sectional area (CSA, mm2) and section modulus (SM, mm3) (139.30 ± 29.08 vs 157.29 ± 22.26, P < .001 and 665.21 ± 129.54 vs 575.53 ± 150.88, P < .001, respectively). The FOA was smaller (124.99 ± 3.18) in women with POI as compared with controls (128.04 ± 3.80; P < .001) at baseline and after adjusting for height and femoral neck BMD. CONCLUSION Alongside lower BMD at multiple sites, the femora of women with POI demonstrate reduced strength and a misalignment with forces transmitted from the upper body. Further research is needed to establish the role of these newly identified features and their role in fracture risk prediction in this population.
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Affiliation(s)
- Navira Samad
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Hanh H Nguyen
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
- Hudson Institute of Medical Research, Melbourne, 3168 VIC, Australia
| | - Julie A Pasco
- Deakin University, IMPACT-Institute for Physical and Mental Health and Clinical Translation, Geelong, 3220 VIC, Australia
- Department of Medicine, Western Health, The University of Melbourne, St Albans, 3021 VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, 3168 VIC, Australia
- Barwon Health, University Hospital Geelong, Geelong, 3220 VIC, Australia
| | - Mark A Kotowicz
- Deakin University, IMPACT-Institute for Physical and Mental Health and Clinical Translation, Geelong, 3220 VIC, Australia
- Department of Medicine, Western Health, The University of Melbourne, St Albans, 3021 VIC, Australia
- Department of Endocrinology & Diabetes, University Hospital Geelong, Barwon Health, Geelong, 3220 VIC, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Monash Centre for Health Research and Implementation, Monash University, 3168 VIC, Australia
| | - Roger Zebaze
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
- Hudson Institute of Medical Research, Melbourne, 3168 VIC, Australia
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Emerzian SR, Johannesdottir F, Yu EW, Bouxsein ML. Use of noninvasive imaging to identify causes of skeletal fragility in adults with diabetes: a review. JBMR Plus 2024; 8:ziae003. [PMID: 38505529 PMCID: PMC10945731 DOI: 10.1093/jbmrpl/ziae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024] Open
Abstract
Diabetes, a disease marked by consistent high blood glucose levels, is associated with various complications such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. Notably, skeletal fragility has emerged as a significant complication in both type 1 (T1D) and type 2 (T2D) diabetic patients. This review examines noninvasive imaging studies that evaluate skeletal outcomes in adults with T1D and T2D, emphasizing distinct skeletal phenotypes linked with each condition and pinpointing gaps in understanding bone health in diabetes. Although traditional DXA-BMD does not fully capture the increased fracture risk in diabetes, recent techniques such as quantitative computed tomography, peripheral quantitative computed tomography, high-resolution quantitative computed tomography, and MRI provide insights into 3D bone density, microstructure, and strength. Notably, existing studies present heterogeneous results possibly due to variations in design, outcome measures, and potential misclassification between T1D and T2D. Thus, the true nature of diabetic skeletal fragility is yet to be fully understood. As T1D and T2D are diverse conditions with heterogeneous subtypes, future research should delve deeper into skeletal fragility by diabetic phenotypes and focus on longitudinal studies in larger, diverse cohorts to elucidate the complex influence of T1D and T2D on bone health and fracture outcomes.
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Affiliation(s)
- Shannon R Emerzian
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
| | - Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
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Naseri A, Shojaeefard E, Bakhshayeshkaram M, Dabbaghmanesh MM, Heydari ST, Talezadeh P, Farhadi M, Nikkhah A, Dabbaghmanesh MH. Hip structural analysis, trabecular bone score, and bone mineral density in post-menopausal women with type-2 diabetes mellitus: a multi-center cross-sectional study in the south of Iran. Arch Osteoporos 2023; 18:98. [PMID: 37454358 DOI: 10.1007/s11657-023-01310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
This study aimed to evaluate bone mineral density (BMD), trabecular microarchitecture, and proximal hip geometry in diabetic postmenopausal women, where BMD alone cannot reflect bone strength adequately. We found significantly lower trabecular bone score and BMD at the distal radius and total forearm in diabetic subjects compared to controls. PURPOSE The limitations resulting from the exclusive assessment of bone mineral density (BMD) in people with diabetes can lead to underestimation of microarchitectural and geometric changes, both of which play an essential role in the fracture risk. Therefore, we aimed to evaluate BMD, trabecular bone score (TBS), and hip structural analysis (HSA) in diabetic type-2 post-menopausal women and compare them with healthy postmenopausal subjects. METHODS BMD was assessed at the lumbar spine, femoral sites, distal radius, and total forearm using dual-energy X-ray absorptiometry (DXA); TBS was measured based on DXA images using the software at the same region of interest as the BMD measurements; geometric assessment at the proximal femur was performed by the HSA program. RESULTS A total of 348 ambulatory type-2 diabetic postmenopausal women and 539 healthy postmenopausal women were enrolled. TBS and BMD at the distal radius and total forearm were significantly (P value < 0.05) lower in cases compared to controls after age and body mass index (BMI) adjustment. In addition, degraded bone microarchitecture was significantly (P value < 0.05) more prevalent in diabetic subjects than in non-diabetic controls after adjusting for age and BMI. A number of geometric indices of the proximal hip were significantly lower in the controls than in those with diabetes (P-value < 0.05). CONCLUSION This study may highlight the utility of the TBS and BMD at the distal radius and total forearm in subjects with type-2 diabetes mellitus, where the BMD at central sites may not adequately predict fracture risk.
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Affiliation(s)
- Arzhang Naseri
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Shojaeefard
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Bakhshayeshkaram
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Talezadeh
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Farhadi
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nikkhah
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Dabbaghmanesh
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Shiraz University of Medical Sciences, Shiraz, Iran.
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Cavati G, Pirrotta F, Merlotti D, Ceccarelli E, Calabrese M, Gennari L, Mingiano C. Role of Advanced Glycation End-Products and Oxidative Stress in Type-2-Diabetes-Induced Bone Fragility and Implications on Fracture Risk Stratification. Antioxidants (Basel) 2023; 12:antiox12040928. [PMID: 37107303 PMCID: PMC10135862 DOI: 10.3390/antiox12040928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Type 2 diabetes (T2D) and osteoporosis (OP) are major causes of morbidity and mortality that have arelevant health and economic burden. Recent epidemiological evidence suggests that both of these disorders are often associated with each other and that T2D patients have an increased risk of fracture, making bone an additional target of diabetes. As occurs for other diabetic complications, the increased accumulation of advanced glycation end-products (AGEs) and oxidative stress represent the major mechanisms explaining bone fragility in T2D. Both of these conditions directly and indirectly (through the promotion of microvascular complications) impair the structural ductility of bone and negatively affect bone turnover, leading to impaired bone quality, rather than decreased bone density. This makes diabetes-induced bone fragility remarkably different from other forms of OP and represents a major challenge for fracture risk stratification, since either the measurement of BMD or the use of common diagnostic algorithms for OP have a poor predictive value. We review and discuss the role of AGEs and oxidative stress on the pathophysiology of bone fragility in T2D, providing some indications on how to improve fracture risk prediction in T2D patients.
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Affiliation(s)
- Guido Cavati
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Filippo Pirrotta
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Daniela Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Elena Ceccarelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Marco Calabrese
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Christian Mingiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
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Zhang M, Li Y, Liu L, Huang M, Wang M, Zou J. The effects on type 2 diabetes mellitus mouse femoral bone achieved by anti-osteoporosis exercise interventions. Front Endocrinol (Lausanne) 2022; 13:914872. [PMID: 36465647 PMCID: PMC9715737 DOI: 10.3389/fendo.2022.914872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Exercise therapy and key regulators of bone quality exert anti-hyperglycemic effects on type 2 diabetes mellitus (T2DM) mice. A number of programs have been reported to have an effect on bone disease in T2DM. Major unanswered questions concern the potential correlation of exercise with the improvement of bone quality in T2DM mice and how the nonlinear optical properties of bone are correlated with changes to its crystal structure. Methods Subjects were randomly divided into six groups: 1) control (C) group, which was fed a normal diet (n = 8); 2) T2DM quiet group, which was given a high-fat diet and quiet (n = 8); 3) T2DM plus swimming (T2DM+S) group, which received T2DM and swim training (n = 8); 4) T2DM plus resistance exercise (T2DM+RE) group, which was given T2DM and resistance exercise (n = 8); 5) T2DM plus aerobic exercise (T2DM+AE) group, with T2DM and medium-intensity treadmill exercise (n = 8); and 6) T2DM plus high-intensity interval training (T2DM+HIIT), with T2DM and high-intensity variable-speed intervention (n = 8). The levels of runt-related transcription factor 2 (RUNX2), osterix (OSX), and alkaline phosphatase (ALP), as well as the bone microstructure and morphometry, were measured at the end of the 8-week exercise intervention. Results Compared with the C group, the bone microstructure indexes [bone mineral density (BMD), bone volume/tissue volume (BV/TV), cortical thickness (Ct.Th), and connectivity density (Conn.D)], the bone biomechanical properties (maximum load, fracture load, yield stress, and elastic modulus), and the osteogenic differentiation factors (RUNX2, OSX, and BMP2) of the T2DM group were significantly decreased (all p < 0.05). Compared with the T2DM group, there were obvious improvements in the osteogenic differentiation factor (OSX) and Th.N, while the separation of trabecular bone (Tb.Sp) decreased in the T2DM+AE and T2DM+HIIT groups (all p < 0.05). In addition, the bone microstructure indicators BV/TV, tissue mineral density (TMD), Conn.D, and degree of anisotropy (DA) also increased in the T2DM+HIIT group, but the yield stress and Ct.Th deteriorated compared with the T2DM group (all p < 0.05). Compared with the T2DM+S and T2DM+RE groups, the BV/TV, trabecular number (Tb.N), Tb.Sp, and Conn.D in the T2DM+AE and T2DM+HIIT groups were significantly improved, but no significant changes in the above indicators were found between the T2DM+S and T2DM+RE groups (all p < 0.05). In addition, the BMD and the expression of ALP in the T2DM+AE group were significantly higher than those in the T2DM+HIIT group (all p < 0.05). Conclusion There was a significant deterioration in femur bone mass, trabecular bone microarchitecture, cortical bone geometry, and bone mechanical strength in diabetic mice. However, such deterioration was obviously attenuated in diabetic mice given aerobic and high-intensity interval training, which would be induced mainly by suppressing the development of T2DM. Regular physical exercise may be an effective strategy for the prevention of not only the development of diabetes but also the deterioration of bone properties in patients with chronic T2DM.
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Affiliation(s)
- Miao Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yuexuan Li
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lifei Liu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation, The People’s Hospital of Liaoning Province, Shenyang, China
| | - Mei Huang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Miao Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jun Zou
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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6
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Chiodini I, Gaudio A, Palermo A, Napoli N, Vescini F, Falchetti A, Merlotti D, Eller-Vainicher C, Carnevale V, Scillitani A, Pugliese G, Rendina D, Salcuni A, Bertoldo F, Gonnelli S, Nuti R, Toscano V, Triggiani V, Cenci S, Gennari L. Management of bone fragility in type 2 diabetes: Perspective from an interdisciplinary expert panel. Nutr Metab Cardiovasc Dis 2021; 31:2210-2233. [PMID: 34059385 DOI: 10.1016/j.numecd.2021.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 12/22/2022]
Abstract
AIM Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D. DATA SYNTHESIS The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively. CONCLUSIONS Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting.
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Affiliation(s)
- Iacopo Chiodini
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medical Science and Community Health, University of Milan, Milan, Italy
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital "G. Rodolico" Catania, Italy
| | - Andrea Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Nicola Napoli
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. M. Misericordia of Udine, Italy
| | - Alberto Falchetti
- Unit for Bone Metabolism Diseases and Diabetes and Lab of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Milan, Italy; EndOsMet, Villa Donatello Private Hospital, Florence, Italy
| | - Daniela Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy; Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Vincenzo Carnevale
- Unit of Internal Medicine, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, (FG), Italy
| | - Alfredo Scillitani
- Unit of Endocrinology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, (FG), Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Antonio Salcuni
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Bertoldo
- Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Ranuccio Nuti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Vincenzo Toscano
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. University of Bari "Aldo Moro", Bari, Italy
| | - Simone Cenci
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy.
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Abstract
Diabetes-induced osteoporosis is characterized by an increase in fracture risk. FRAX, the most widely used tool, underestimates the risk of fracture in both type 1 and type 2 diabetes. Specific adjustments to FRAX can help to better identify patients with diabetes at increased risk of fracture and select those at high fracture risk for treatment. Although clinical trial data are limited, the available evidence indicates that the presence of diabetes does not alter antiosteoporotic treatment response in patients with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, GF-335, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - William D Leslie
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, C5121, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
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8
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Parle E, Tio S, Behre A, Carey JJ, Murphy CG, O'Brien TF, Curtin WA, Kearns SR, McCabe JP, Coleman CM, Vaughan TJ, McNamara LM. Bone Mineral Is More Heterogeneously Distributed in the Femoral Heads of Osteoporotic and Diabetic Patients: A Pilot Study. JBMR Plus 2020; 4:e10253. [PMID: 32149268 PMCID: PMC7017882 DOI: 10.1002/jbm4.10253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/23/2019] [Accepted: 11/03/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is associated with systemic bone loss, leading to a significant deterioration of bone microarchitecture and an increased fracture risk. Although recent studies have shown that the distribution of bone mineral becomes more heterogeneous because of estrogen deficiency in animal models of osteoporosis, it is not known whether osteoporosis alters mineral distribution in human bone. Type 2 diabetes mellitus (T2DM) can also increase bone fracture risk and is associated with impaired bone cell function, compromised collagen structure, and reduced mechanical properties. However, it is not known whether alterations in mineral distribution arise in diabetic (DB) patients’ bone. In this study, we quantify mineral content distribution and tissue microarchitecture (by μCT) and mechanical properties (by compression testing) of cancellous bone from femoral heads of osteoporotic (OP; n = 10), DB (n = 7), and osteoarthritic (OA; n = 7) patients. We report that though OP cancellous bone has significantly deteriorated compressive mechanical properties and significantly compromised microarchitecture compared with OA controls, there is also a significant increase in the mean mineral content. Moreover, the heterogeneity of the mineral content in OP bone is significantly higher than controls (+25%) and is explained by a significant increase in bone volume at high mineral levels. We propose that these mineral alterations act to exacerbate the already reduced bone quality caused by reduced cancellous bone volume during osteoporosis. We show for the first time that cancellous bone mineralization is significantly more heterogeneous (+26%) in patients presenting with T2DM compared with OA (non‐DB) controls, and that this heterogeneity is characterized by a significant increase in bone volume at low mineral levels. Despite these mineralization changes, bone microarchitecture and mechanical properties are not significantly different between OA groups with and without T2DM. Nonetheless, the observed alterations in mineral heterogeneity may play an important tissue‐level role in bone fragility associated with OP and DB bone. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Eoin Parle
- Department of Biomedical Engineering National University of Ireland Galway Galway Ireland
| | - Sherdya Tio
- Department of Biomedical Engineering National University of Ireland Galway Galway Ireland
| | - Annie Behre
- Department of Bioengineering Lehigh University Bethlehem PA USA
| | - John J Carey
- Department of Rheumatology Galway University Hospitals Galway Ireland
| | - Colin G Murphy
- Department of Orthopaedics Galway University Hospitals Galway Ireland
| | - Timothy F O'Brien
- Department of Endocrinology Galway University Hospitals Galway Ireland
| | - William A Curtin
- Department of Orthopaedics Galway University Hospitals Galway Ireland
| | - Stephen R Kearns
- Department of Orthopaedics Galway University Hospitals Galway Ireland
| | - John P McCabe
- Department of Orthopaedics Galway University Hospitals Galway Ireland
| | - Cynthia M Coleman
- Department of Biomedical Engineering National University of Ireland Galway Galway Ireland
| | - Ted J Vaughan
- Department of Biomedical Engineering National University of Ireland Galway Galway Ireland
| | - Laoise M McNamara
- Department of Biomedical Engineering National University of Ireland Galway Galway Ireland
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9
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Multicomponent Exercise Improves Hemodynamic Parameters and Mobility, but Not Maximal Walking Speed, Transfer Capacity, and Executive Function of Older Type II Diabetic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4832851. [PMID: 29651436 PMCID: PMC5832170 DOI: 10.1155/2018/4832851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/13/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Abstract
The present study aimed to investigate the effects of a 6-month multicomponent exercise program (MCEP) on functional, cognitive, and hemodynamic parameters of older Type 2 diabetes mellitus (T2DM) patients. Moreover, additional analyses were performed to evaluate if T2DM patients present impaired adaptability in response to physical exercise when compared to nondiabetic volunteers. A total of 72 T2DM patients and 72 age-matched healthy volunteers (CG) were recruited and submitted to functional, cognitive, and hemodynamic evaluations before and after six months of a MCEP. The program of exercise was performed twice a week at moderate intensity. Results indicate T2DM and nondiabetic patients present an increase in mobility (i.e., usual walking speed) after the MCEP. However, improvements in maximal walking speed, transfer capacity, and executive function were only observed in the CG. On the other hand, only T2DM group reveals a marked decline in blood pressure. In conclusion, data of the current study indicate that a 6-month MCEP improves mobility and reduce blood pressure in T2DM patients. However, maximal walking speed, transfer capacity, and executive function were only improved in CG, indicating that T2DM may present impaired adaptability in response to physical stimulus.
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Takamine Y, Ichinoseki-Sekine N, Tsuzuki T, Yoshihara T, Naito H. Effects of voluntary running exercise on bone histology in type 2 diabetic rats. PLoS One 2018; 13:e0193068. [PMID: 29447298 PMCID: PMC5814042 DOI: 10.1371/journal.pone.0193068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/02/2018] [Indexed: 12/22/2022] Open
Abstract
The incidence of obesity in children and adolescents, which may lead to type 2 diabetes, is increasing. Exercise is recommended to prevent and improve diabetes. However, little is known about the bone marrow environment at the onset of diabetes in the young, and it is unclear whether exercise training is useful for maintaining bone homeostasis, such as mechanical and histological properties. Thus, this study clarified the histological properties of bone and whether exercise contributes to maintaining bone homeostasis at the onset of type 2 diabetes in rats. Four-week-old male Otsuka Long-Evans Tokushima Fatty (OLETF; n = 21) rats as a diabetic model and Long-Evans Tokushima Otsuka (LETO; n = 18) rats as a control were assigned randomly to four groups: the OLETF sedentary group (O-Sed; n = 11), OLETF exercise group (O-Ex; n = 10), LETO sedentary group (L-Sed; n = 9), and LETO exercise group (L-Ex; n = 9). All rats in the exercise group were allowed free access to a steel running wheel for 20 weeks (5-25 weeks of age). In the glucose tolerance test, blood glucose level was higher in the O-Sed group than that in the L-Sed and L-Ex groups, and was markedly suppressed by the voluntary running exercise of O-Ex rats. The energy to fracture and the two-dimensional bone volume at 25 weeks of age did not differ significantly among the groups, though the maximum breaking force and stiffness were lower in OLETF rats. However, bone marrow fat volume was greater in O-Sed than that in L-Sed and L-Ex rats, and was markedly suppressed by wheel running in the O-Ex rats. Our results indicate that exercise has beneficial effects not only for preventing diabetes but also on normal bone remodeling at an early age.
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Affiliation(s)
- Yuri Takamine
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Noriko Ichinoseki-Sekine
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
- Faculty of Liberal Arts, The Open University of Japan, Chiba, Chiba, Japan
| | - Takamasa Tsuzuki
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Toshinori Yoshihara
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
- * E-mail:
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11
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Bonaccorsi G, Fila E, Messina C, Maietti E, Ulivieri FM, Caudarella R, Greco P, Guglielmi G. Comparison of trabecular bone score and hip structural analysis with FRAX ® in postmenopausal women with type 2 diabetes mellitus. Aging Clin Exp Res 2017; 29:951-957. [PMID: 27722900 DOI: 10.1007/s40520-016-0634-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versus Fracture Risk Calculator (FRAX®) as well as whether TBS can improve the fracture prediction ability of FRAX® in diabetic women. METHODS Eighty diabetic postmenopausal women were matched with 88 controls without major diseases for age and body mass index. The individual 10-year fracture risk was assessed by FRAX® tool for Europe-Italy; bone mineral density (BMD) at lumbar spine, femoral neck and total hip was evaluated through dual-energy X-ray absorptiometry; TBS measurements were taken using the same region of interest as the BMD measurements; HSA was performed at proximal femur with the HSA software. RESULTS Regarding variables of interest, the only significant difference between diabetic and control groups was observed for the value of TBS (median value: 1.215; IQR 1.138-1.285 in controls vs. 1.173; IQR 1.082-1.217 in diabetic; p = 0.002). The prevalence of fractures in diabetic women was almost tripled than in controls (13.8 vs. 3.4 %; p = 0.02). The receiver operator characteristic curve analysis showed that TBS alone (AUC = 0.71) had no significantly lower discriminative power for fracture prediction in diabetic women than FRAX major adjusted for TBS (AUC = 0.74; p = 0.65). CONCLUSION In diabetic postmenopausal women TBS is an excellent tool in identifying fragility fractures.
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Abstract
The World Health Organization estimates that diabetes mellitus occurs in more than 415 million people; this number could double by the year 2040. Epidemiologic data have shown that the skeletal system may be a target of diabetes-mediated damage, leading to the development of diabetes-induced osteoporosis. T1D and T2D have been associated with an increased risk of fracture. Bone mineral density and fracture risk prediction tools developed for the general population capture some of the risk associated with diabetes. Recent adaptations to these tools have improved their efficacy in patients with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, University of Manitoba, GF-335, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, C5121, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
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13
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Schacter GI, Leslie WD. DXA-Based Measurements in Diabetes: Can They Predict Fracture Risk? Calcif Tissue Int 2017; 100:150-164. [PMID: 27591864 DOI: 10.1007/s00223-016-0191-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/27/2016] [Indexed: 02/06/2023]
Abstract
In the absence of a fragility fracture, osteoporosis is usually diagnosed from bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). Osteoporosis is an increasingly prevalent disease, as is diabetes [in particular type 2 diabetes (T2D)], in part due to aging populations worldwide. It has been suggested that an increased risk of fracture may be another complication ensuing from longstanding diabetes. The purpose of this review is to concentrate on skeletal parameters and techniques readily available from DXA scanning, and their utility in routine clinical practice for predicting fracture risk. In addition to BMD, other applications and measures from DXA include trabecular bone score (TBS), skeletal geometry and DXA-based finite-element analysis, vertebral fracture assessment, and body composition. In type 1 diabetes (T1D), BMD and FRAXR (when secondary osteoporosis is included without BMD) only partially account for the excess risk of fracture in T1D. Consistent data exist to show that BMD and FRAXR can be used to stratify fracture risk in T2D, but do not account for the increased risk of fracture. However, several adjustments to the FRAX score can be made as proxies for T2D to inform the use of FRAX by primary care practitioners. Examples include using the rheumatoid arthritis input (as a proxy for T2D), lumbar spine TBS (to adjust FRAX probability) or an altered hip T-score (lowered by 0.5 units). These adjustments can improve fracture risk prediction in T2D and help to avoid systematically underestimating the risk of osteoporosis-related fractures in those with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- , 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
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14
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Neglia C, Argentiero A, Chitano G, Agnello N, Ciccarese R, Vigilanza A, Pantile V, Argentiero D, Quarta R, Rivezzi M, Di Tanna GL, Di Somma C, Migliore A, Iolascon G, Gimigliano F, Distante A, Piscitelli P. Diabetes and Obesity as Independent Risk Factors for Osteoporosis: Updated Results from the ROIS/EMEROS Registry in a Population of Five Thousand Post-Menopausal Women Living in a Region Characterized by Heavy Environmental Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111067. [PMID: 27809297 PMCID: PMC5129277 DOI: 10.3390/ijerph13111067] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Objectives: We aimed to analyze bone mineralization and the effect of different risk factors for osteoporosis in postmenopausal women. Methods: We found 4909 postmenopausal subjects within ≥10,000 records from the ROIS/EMEROS (Ionian and Salento Osteoporosis Registry/Euro Mediterranean Registry of Osteoporosis) registry, a population study carried out in an area characterized by heavy environmental pressure between Brindisi and Taranto from 2009 to 2016. All subjects were assessed via phalangeal quantitative ultrasound (QUS) to evaluate their bone mineralization (assessed via amplitude dependent speed of sound (AD-SoS)) and the association between demineralization and the presence of other conditions or risk factors. Results: Mean age was 64 ± 9.5 years and mean body mass index (BMI) was 28.7 ± 3.5 kg/m². Pearson correlation analyses revealed a negative association between bone mineralization (AD-SoS) and BMI (p < 0.001). By using multivariate logistic regression analysis, we observed significant values of odds ratios (ORs) of osteoporosis (adjusted for age, physical activity, and the use of drugs known to increase the risk of fractures) in subjects with diabetes and obesity: 1.39 (confidence interval (CI): 1.05-1.83) and 1.46 (CI: 1.20-1.78), respectively. A statistically significant linear trend of higher ORs of osteoporosis was found for increasing values of BMI. Conclusions: Our study confirmed the high impact of obesity and type 1 and type 2 diabetes on osteoporosis.
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Affiliation(s)
- Cosimo Neglia
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Alberto Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Giovanna Chitano
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Nadia Agnello
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Roberta Ciccarese
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Antonella Vigilanza
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Valerio Pantile
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Domenico Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Raffaele Quarta
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Matteo Rivezzi
- IOS, Southern Italy Hospital Institute, Medicina Futura Research, Naples 80100, Italy.
| | - Gian Luca Di Tanna
- Centre for Primary Care and Public Health, Queen Mary University of London, London E1 4NS, UK.
| | - Carolina Di Somma
- IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples 80133, Italy.
| | | | - Giovanni Iolascon
- Department of Orthopaedic Surgery and Rehabilitation, Second University of Naples, Naples 81100, Italy.
| | - Francesca Gimigliano
- Department of Orthopaedic Surgery and Rehabilitation, Second University of Naples, Naples 81100, Italy.
| | - Alessandro Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi 72100, Italy.
| | - Prisco Piscitelli
- IOS, Southern Italy Hospital Institute, Medicina Futura Research, Naples 80100, Italy.
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15
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Niu Y, Zhang W, Yang Z, Li X, Fang W, Zhang H, Wang S, Zhou H, Fan J, Qin L, Su Q. Plasma osteoprotegerin levels are inversely associated with nonalcoholic fatty liver disease in patients with type 2 diabetes: A case-control study in China. Metabolism 2016; 65:475-81. [PMID: 26975539 DOI: 10.1016/j.metabol.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor (TNF) receptor superfamily, is a decoy receptor for the receptor activator of nucleus factor-κB ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL). OPG has an effect on systemic insulin sensitivity and glucose homeostasis. The objective of this study was to evaluate the relationship between plasma osteoprotegerin (OPG) levels and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes. MATERIALS/METHODS A case-control study was performed with 746 patients with type 2 diabetes. Of the study population, 367 patients had B-mode ultrasound-proven NAFLD and 379 were controls. The plasma OPG levels were measured using ELISA methods. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases. RESULTS The OPG levels were significantly decreased in patients with NAFLD (2.3±1.1μg/L vs. 2.8±1.3μg/L, p=3.75×10(5)) compared to controls. Pearson correlation analysis showed that the OPG levels were associated with age and systolic blood pressure (both p<0.05). The participants in the lowest OPG quartile had a significantly increased risk for NAFLD (OR=3.49, 95% CI 1.86-6.94) after adjusting for potential cofounders. CONCLUSIONS The plasma OPG level is negatively associated with NAFLD independent of potential cofounders.
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Affiliation(s)
- Yixin Niu
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Zhang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhen Yang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenjun Fang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Suijun Wang
- Department of Endocrinology, Clinical Geriatric Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Houguang Zhou
- Department of Geriatrics, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiangao Fan
- Department of Gastroenterology, Shanghai Key Laboratory of Children's Digestion and Nutrition, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Qin
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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16
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Choi YJ, Chung YS. Type 2 diabetes mellitus and bone fragility: Special focus on bone imaging. Osteoporos Sarcopenia 2016; 2:20-24. [PMID: 30775463 PMCID: PMC6372751 DOI: 10.1016/j.afos.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 12/05/2022] Open
Abstract
Fragility fracture rate is increased in type 2 diabetes patients despite of higher bone mineral density than non-diabetes control subjects. Vertebral fractures are usually asymptomatic; therefore, morphometric radiologic evaluation should be considered especially for diabetes patients. Bone quality may more contribute to the increased risk of osteoporotic fractures in patients with type 2 diabetes than bone mass. Hip geometry, cortical porosity, and trabecular bone score have been studied as bone quality parameters by imaging in type 2 diabetes mellitus.
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Affiliation(s)
- Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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17
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Abstract
Conventional dual-energy X-ray absorptiometry images display a digital projection of the inorganic mineral mass in a scanned region. Bone mineral density software generates an average of the pixels within one or more regions. Although not used in the conventional analysis, the images also contain dimensional information limited to the plane of the image. The hip structure analysis method and that of the similar GE, Madison, WI, algorithm Advanced Hip Analysis use both the dimensional information and the mineral mass data to compute the types of dimensional properties (i.e., geometry) that are used to evaluate mechanical strength in engineering analyses. This article describes the hip structure analysis method and a somewhat cruder geometry approximation that does not require a reanalysis of the image. Limitations of the methods are discussed.
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Affiliation(s)
- Thomas J Beck
- Beck Radiological Innovations, Cantonsville, MD, USA.
| | - Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA
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18
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Carnevale V, Romagnoli E, D'Erasmo L, D'Erasmo E. Bone damage in type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2014; 24:1151-1157. [PMID: 25150773 DOI: 10.1016/j.numecd.2014.06.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/18/2014] [Accepted: 06/30/2014] [Indexed: 01/22/2023]
Abstract
This review focuses on the mechanisms determining bone fragility in patients with type 2 diabetes mellitus (T2DM). Despite bone mineral density (BMD) is usually normal or more often increased in these patients, fracture incidence is high, probably because of altered bone "quality". The latter seems to depend on several, only partly elucidated, mechanisms, such as the increased skeletal content of advanced glycation end-products causing collagen deterioration, the altered differentiation of bone osteogenic cells, the altered bone turnover and micro-architecture. Disease duration, its severity and metabolic control, the type of therapy, the presence or absence of complications, as like as the other known predictors for falls, are all relevant contributing factors affecting fracture risk in T2DM. In these patients the estimate of fracture risk in the everyday clinical practice may be challenging, due to the lower predictive capacity of both BMD and risk factors-based algorithms (e.g. FRAX).
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Affiliation(s)
- V Carnevale
- Unit of Internal Medicine, "Casa Sollievo della Sofferenza" Hospital, IRCCS, Viale dei Cappuccini snc, 71013 San Giovanni Rotondo, FG, Italy.
| | - E Romagnoli
- Department of Experimental Medicine, "Sapienza" University, Viale del Policlinico 155, 00161 Rome, Italy
| | - L D'Erasmo
- Department of Internal Medicine and Medical Specialties, "Sapienza" University, Viale del Policlinico 155, 00161 Rome, Italy
| | - E D'Erasmo
- Department of Internal Medicine and Medical Specialties, "Sapienza" University, Viale del Policlinico 155, 00161 Rome, Italy
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19
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Piodi LP, Poloni A, Ulivieri FM. Managing osteoporosis in ulcerative colitis: something new? World J Gastroenterol 2014; 20:14087-98. [PMID: 25339798 PMCID: PMC4202340 DOI: 10.3748/wjg.v20.i39.14087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/12/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX(®) tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
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20
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Neglia C, Argentiero A, Chitano G, Agnello N, Giolli L, Di Tanna G, Paladini D, Amati A, Marsico A, Caiaffa V, Conte P, La Selva G, Crafa S, Colì G, Ciccarese R, Vigilanza A, Distante C, Argentiero D, Pantile V, Benvenuto M, Di Renzo T, Reale A, Coppola R, Distante A, Colao A, Di Somma C, Migliore A, Auriemma R, Piscitelli P. Diabetes and Obesity as Independent Risk Factors for Osteoporosis in Postmenopausal Women: A Population Study. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to analyze bone mineralization and the effect of different risk factors for osteoporosis in postmenopausal women. We studied 2,756 postmenopausal subjects out of ≥10,000 records from the ROIS registry in the frame of the PROF Project, a population study carried out in Salento (Taranto, Brindisi, Lecce) from 2009 to 2012. All subjects were assessed by phalangeal Quantitative Ultrasound (QUS) to evaluate their bone mineralization (assessed by Amplitude Dependent Speed of Sound, AD-SoS) and the association between demineralization and the presence of other conditions or risk factors. Mean age was 64±9.5 years and mean BMI was 28.7±3.5 Kg/m2. Pearson correlation analyses revealed a negative association between bone mineralization (AD-SoS) and BMI (P<0.001). By using multivariate logistic regression analysis, we observed significant values of Odds Ratios of osteoporosis (adjusted for age, physical activity and the use of drugs known to increase the risk of fractures) in subjects with diabetes and obesity: 1.39 (CI: 1,05–1,83) and 1.46 (CI: 1.20–1.78), respectively. A statistically significant linear trend of higher Odds Ratios of osteoporosis was found for increasing values of BMI. The percent change in the odds of vertebral fractures per single SD decrease of AD-SoS was 47% (P<0.001). Diabetes and obesity in postmenopausal women are likely to represent independent risk factors for osteoporosis. Phalangeal QUS showed a good power of predictivity in identifying subjects with vertebral fractures.
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Affiliation(s)
- C. Neglia
- Department of Biological and Environmental Science and Technology (Di.S.T.E.B.A), University of Salento, Lecce, Italy
| | - A. Argentiero
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G. Chitano
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - N. Agnello
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - L. Giolli
- E-Campus University, Novedrate, Italy
| | | | - D. Paladini
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Amati
- Local Health Authority, ASL Taranto Taranto, Italy
| | - A. Marsico
- Local Health Authority, ASL Taranto Taranto, Italy
| | - V. Caiaffa
- Local Health Authority, ASL Taranto Taranto, Italy
| | - P. Conte
- Local Health Authority, ASL Taranto Taranto, Italy
| | - G. La Selva
- Local Health Authority, ASL Brindisi, Brindisi, Italy
| | - S. Crafa
- Local Health Authority, ASL Taranto Taranto, Italy
| | - G. Colì
- Local Health Authority, ASL Lecce, Gallipoli Hospital, Gallipoli, Italy
| | - R. Ciccarese
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Vigilanza
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - C. Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - D. Argentiero
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - V. Pantile
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - M. Benvenuto
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | | | | | | | - A. Distante
- ISBEM (Istituto Scientifico Biomedico Euro Mediterraneo), Brindisi, Italy
| | - A. Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - A. Migliore
- Fatebenefratelli St. Peter's Hospital- Department of Rheumatology, Rome, Italy
| | - R. Auriemma
- IOS, Southern Italy Hospital Institute, Naples, Italy
- Coleman Ltd, Naples, Italy
| | - P. Piscitelli
- IOS, Southern Italy Hospital Institute, Naples, Italy
- Coleman Ltd, Naples, Italy
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21
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Michalopoulou M, Kambas A, Leontsini D, Chatzinikolaou A, Draganidis D, Avloniti A, Tsoukas D, Michopoulou E, Lyritis GP, Papaioannou N, Tournis S, Fatouros IG. Physical activity is associated with bone geometry of premenarcheal girls in a dose-dependent manner. Metabolism 2013; 62:1811-8. [PMID: 24054822 DOI: 10.1016/j.metabol.2013.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the relationship between habitual physical activity (PA) level and peripheral qualitative computed tomography-determined quantitative tibia characteristics of premenarcheal girls. METHODS Premenarcheal girls matched for age (10-13 years), bone age and maturity level were assigned into: a) low PA group (LPA, n=25), b) moderate PA group (MPA, n=17), and c) high PA group (HPA, n=18). Participants' daily dietary intake, tibia's geometry and serum levels of calcium and vitamin D were assessed. RESULTS Premenarcheal girls demonstrating HPA exhibited greater pericortical thickness, cross-sectional area (CSA) and bone mineral content (BMC) (p<.001) in cortical bone, greater BMC, volumetric bone density (vBMD) and polar stress strength index (SSIp) in trabecular bone (p<0.001-0.05) and greater total BMC (p<.05) and vBMD (p<.01) when compared to their physically inactive or moderately active counterparts. MPA exhibited greater values of cortical BMC (p<.01) and SSIp (p<.05) than LPA. Partial correlation analysis (adjusted for BMI) revealed modest associations between PA score and bone geometry parameters (r=0.36-0.49, p<.05) at 38% of tibia length. CONCLUSIONS Habitual PA affects geometry of both cortical and trabecular areas of a long bone of premenarcheal girls in a dose-dependent manner. Specifically, PA increases both the density and size of cortical bone but only the density of trabecular bone during preadolescence. Given the importance of peak bone mass for future fracture risk, high levels of PA during childhood could be a major target for public health interventions aimed at optimising bone health in prepubertal children when the greatest bone gains occur.
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Affiliation(s)
- Maria Michalopoulou
- Department of Physical Education and Sport Sciences, Democritus University of Thrace, University Campus, 69100 Komotini, Greece
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