Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures.
Increased cortical porosity in type 2 diabetic postmenopausal women with fragility fractures.
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DOI：
10.1002/jbmr.1763
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发表时间：
2013-02
影响因子：
6.2
通讯作者：
Link, Thomas M.
中科院分区：
文献类型：
--
作者：
Patsch, Janina M.;Burghardt, Andrew J.;Yap, Samuel P.;Baum, Thomas;Schwartz, Ann V.;Joseph, Gabby B.;Link, Thomas M.
关键词：
本研究的主要目标是评估患有脆性骨折 (DMFx) 的糖尿病绝经后女性的外周骨微结构和强度，并将其与无骨折的糖尿病女性 (DM) 进行比较。次要目标是评估患有（Fx）和不患有脆性骨折（Co）的非糖尿病女性以及患有（DM）和不患有糖尿病（Co）的女性之间的差异。 80 名女性（平均年龄 61.3±5.7 岁）被招募到这些组中（每组 n=20）。参与者接受了 DXA 以及超远端和远端桡骨和胫骨的高分辨率外周定量计算机断层扫描 (HR-pQCT)。在 HR-pQCT 图像中，计算了体积骨矿物质密度、皮质和小梁结构测量值，包括皮质孔隙率。使用微有限元分析（μFEA）评估骨强度。在有和没有开放皮质孔的情况下获得了差异强度估计。在超远端和远端胫骨，DMFx 具有更大的皮质内孔隙体积（+52.6%，p=0.009；+95.4%，p=0.020）、相对孔隙率（+58.1%；p=0.005；+87.9%，p=0.011）和皮质内骨表面（+10.9%，p=0.031；+11.5%， 0.019）比DM。在桡骨远端，DMFx 的相对孔隙率是 DM 的 4.7 倍（p=0.000）。在超远端半径处，DMFx 中的皮质内孔体积显着高于 DM（+67.8%，p=0.018）。与 DM 相比，DMFx 还表现出更大的小梁异质性（远端半径；+36.8%，p=0.035），以及较低的总骨密度和皮质 BMD（胫骨远端：-12.6%，p=0.031；-6.8%，p=0.011）。与 DM 相比，DMFx 在超远端和远端胫骨以及远端桡骨的刚度、失效载荷和皮质载荷分数方面表现出明显更高的孔隙相关缺陷。比较非糖尿病 Fx 和 Co，我们仅发现超远端半径处孔体积增加的非显着趋势 (+38.9%，p=0.060)。我们的研究结果表明，皮质骨质量的严重缺陷是导致绝经后糖尿病女性脆性骨折的原因。
The primary goal of this study was to assess peripheral bone microarchitecture and strength in diabetic postmenopausal women with fragility fractures (DMFx) and to compare them with diabetic women without fracture (DM). Secondary goals were to assess differences in non-diabetic women with (Fx) and without fragility fractures (Co) and in women with (DM) and without diabetes (Co). Eighty women (mean age 61.3±5.7 yrs) were recruited into these groups (n=20 per group). Participants underwent 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, 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%, 0.019) than DM. At the distal radius DMFx had 4.7-fold greater relative porosity (p=0.000) than DM. At the ultradistal radius, intracortical pore volume was significantly higher in DMFx than DM (+67.8%, p=0.018). DMFx also displayed larger trabecular heterogeneity (ultradistal radius; +36.8%, p=0.035), and lower total and cortical BMD (ultradistal tibia: −12.6%, p=0.031; −6.8%, p=0.011) than DM. DMFx exhibited significantly higher pore-related deficits in stiffness, failure load and cortical load fraction at the ultradistal and distal tibia, and the distal radius than DM. Comparing non-diabetic Fx and Co, we only found a non-significant trend with increase in pore volume (+38.9%, p=0.060) at the ultradistal radius. The results of our study suggest that severe deficits in cortical bone quality are responsible for fragility fractures in postmenopausal diabetic women.
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影响因子：
4
作者：
Melton, L. J., III;Christen, D.;Riggs, B. L.;Achenbach, S. J.;Mueller, R.;van Lenthe, G. H.;Amin, S.;Atkinson, E. J.;Khosla, S.
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