High-Resolution Peripheral Quantitative Computed Tomographic Imaging of Cortical and Trabecular Bone Microarchitecture in Patients with Type 2 Diabetes Mellitus
High-Resolution Peripheral Quantitative Computed Tomographic Imaging of Cortical and Trabecular Bone Microarchitecture in Patients with Type 2 Diabetes Mellitus
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DOI：
10.1210/jc.2010-0226
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发表时间：
2010-11-01
影响因子：
5.8
通讯作者：
Link, Thomas M.
中科院分区：
文献类型：
--
作者：
Burghardt, Andrew J.;Issever, Ahi S.;Link, Thomas M.
背景：横断面流行病学研究发现，尽管骨密度(BMD)正常或升高，但2型糖尿病(T2 DM)患者的某些脆性骨折的发生率较高。目的：本研究应用高分辨率外周定量CT来表征女性T2 DM患者外周骨骼的皮质和骨小梁微结构和生物力学。设计和背景：一项横断面研究来自糖尿病门诊患者。招募有T2 DM病史(n=19)和年龄和身高匹配的对照组(n=19)的62.9+/-7.7岁的受试者。结果：受试者使用高分辨率外周定量CT对受试者的桡骨和胫骨进行成像。计算体积(BMD)、横断面几何、骨小梁和皮质微结构的定量测量。结果：与对照组相比，T2 DM组邻近皮质的骨小梁体积骨密度增加10%(P<；0.05)，胫骨小梁厚度增加13.8%(P<；0.05)。仅皮质孔隙率差异与骨质强度受损是一致的，且在桡骨有显著差异(+50%；P<；0.05)，而在胫骨则接近显著(+118%；P=0.1)。结论：这项初步调查的结果提供了一个潜在的解释，即标准骨密度测量方法无法解释T2 DM患者骨折发生率升高的原因。研究结果提示，T2 DM可能与弯曲负荷抵抗力受损有关，这是由于骨量重新分配效率低下，其特征是皮质内骨丢失被骨小梁密度的升高所抵消。(临床内分泌代谢酶95：5045-5055,2010)
Context: Cross-sectional epidemiological studies have found that patients with type 2 diabetes mellitus (T2DM) have a higher incidence of certain fragility fractures despite normal or elevated bone mineral density (BMD).Objective: In this study, high-resolution peripheral quantitative computed tomography was applied to characterize cortical and trabecular microarchitecture and biomechanics in the peripheral skeleton of female patients with T2DM.Design and Setting: A cross-sectional study was conducted in patients with T2DM recruited from a diabetic outpatient clinic.Participants: Elderly female patients (age, 62.9 +/- 7.7 yr) with a history of T2DM (n = 19) and age- and height-matched controls (n = 19) were recruited.Outcome Measures: Subjects were imaged using high-resolution peripheral quantitative computed tomography at the distal radius and tibia. Quantitative measures of volumetric (BMD), cross-sectional geometry, trabecular and cortical microarchitecture were calculated. Additionally, compressive mechanical properties were determined by micro-finite element analysis.Results: Compared to the controls, the T2DM cohort had 10% higher trabecular volumetric BMD(P < 0.05) adjacent to the cortex and higher trabecular thickness in the tibia (13.8%; P < 0.05). Cortical porosity differences alone were consistent with impaired bone strength and were significant in the radius (>+50%; P < 0.05), whereas pore volume approached significance in the tibia (+118%; P = 0.1).Conclusion: The results of this pilot investigation provide a potential explanation for the inability of standard BMD measures to explain the elevated fracture incidence in patients with T2DM. The findings suggest that T2DM may be associated with impaired resistance to bending loads due to inefficient redistribution of bone mass, characterized by loss of intracortical bone offset by an elevation in trabecular bone density. (J Clin Endocrinol Metab 95: 5045-5055, 2010)