Imaging techniques to study diabetic bone disease.
Imaging techniques to study diabetic bone disease.
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DOI：
10.1097/med.0000000000000749
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发表时间：
2022-08-01
影响因子：
3.2
通讯作者：
Carballido-Gamio, Julio
中科院分区：
文献类型：
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作者：
Carballido-Gamio, Julio
关键词：
这篇综述文章从医学影像学的角度介绍了糖尿病患者骨脆性的最新研究。双能X线吸收测定法（DXA）和松质骨评分（TBS）软件的广泛使用，导致最近在一些2型糖尿病（T2 D）研究中使用该纹理参数评估骨脆性，但在少数1型糖尿病（T1 D）研究中使用。尽管大多数研究显示T2 D患者TBS值降低的趋势与腰椎的面积骨矿物质密度（aBMD）无关，但一些研究也显示了TBS在T2 D和T1 D中的局限性。由于DXA在评估骨强度和研究糖尿病骨脆性病因方面的局限性，更多的研究人员正在将三维（3D）医学成像技术纳入他们的研究中。最近使用3D医学成像来评估糖尿病患者的骨脆性主要局限于少数几项横断面研究，主要包括高分辨率外周定量计算机断层扫描（HR-pQCT）。虽然HR-pQCT研究表明T2 D受试者的胫骨皮质孔隙率较高，但由于研究设计、样本量和受试者特征等因素的差异，T1 D的结果不一致。关于中央CT，最近的研究支持文献中先前的发现，即T2 D受试者的股骨颈几何损伤，并为在T2 D研究中纳入有限元分析（FEA）评估骨强度提供了令人鼓舞的结果。在最近的文献中，没有使用QCT评估T1 D骨脆性的研究，只有两项研究使用pQCT分别报告了T1 D年轻女性和儿童的胫骨和桡骨损伤。磁共振成像（MRI）最近尚未用于糖尿病骨脆性的研究。由于DXA衍生的aBMD无法解释糖尿病患者的骨脆性，并且鉴于横断面研究的局限性，因此必须使用3D成像技术对骨的密度、质量和微环境进行纵向评估，以提高我们对糖尿病对骨影响的理解，并降低糖尿病患者这一庞大且脆弱的受试者人群的骨折风险。
This review article presents the most recent research on bone fragility in individuals with diabetes from a medical imaging perspective. The widespread availability of dual-energy X-ray absorptiometry (DXA) and trabecular bone score (TBS) software has led to recent assessments of bone fragility with this texture parameter in several studies of type 2 diabetes mellitus (T2D), but in few of type 1 diabetes mellitus (T1D). Although most studies show a trend of reduced TBS values in T2D independent of areal bone mineral density (aBMD) of the lumbar spine, some studies also show the limitations of TBS in both T2D and T1D. Given the limitations of DXA to assess bone strength and investigate the etiology of bone fragility in diabetes, more investigators are incorporating three-dimensional (3D) medical imaging techniques in their studies. Recent use of 3D medical imaging to assess bone fragility in the setting of diabetes has been mostly limited to a few cross-sectional studies predominantly incorporating high-resolution peripheral quantitative computed tomography (HR-pQCT). While HR-pQCT studies indicate higher tibial cortical porosity in subjects with T2D, results are inconsistent in T1D due to differences in study designs, sample sizes, and subject characteristics, among other factors. With respect to central CT, recent studies support a previous finding in the literature indicating femoral neck geometrical impairments in subjects with T2D and provide encouraging results for the incorporation of finite element analysis (FEA) to assess bone strength in studies of T2D. In the recent literature, there are no studies assessing bone fragility in T1D with QCT, and only two studies used pQCT reporting tibial and radial impairments in young women and children with T1D, respectively. Magnetic resonance imaging (MRI) has not been recently used in diabetic studies of bone fragility. As bone fragility in diabetes is not explained by DXA-derived aBMD and given the limitations of cross-sectional studies, it is imperative to use 3D imaging techniques for longitudinal assessments of the density, quality, and microenvironment of bone to improve our understanding of the effects of diabetes on bone and reduce the risk of fracture in this large and vulnerable population of subjects with diabetes.