Computed Tomography to Identify Structural Mechanisms of Hip Fragility in T1DM

计算机断层扫描识别 T1DM 髋部脆弱的结构机制

• 批准号: 10037479
• 负责人: Fjola Johannesdottir
• 金额: $ 8.75万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10037479
• 关键词: 3-Dimensional; Abdomen; Accounting; Address; Adult; Affect; Age; Age of Onset; Age-Years; Anterior; Architecture; Area; Biomechanics; Bone Density; Bone Tissue; Bone structure; Characteristics; Clinical; Defect; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Dual-Energy X-Ray Absorptiometry; Elderly; Femur; Fracture; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Height; Hip Fractures; Hip region structure; Hyperglycemia; Incidence; Individual; Inferior; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Life Expectancy; Measurement; Measures; Mediating; Medical Records; Microvascular Dysfunction; Morbidity - disease rate; Neck; Newly Diagnosed; Outcome; Patients; Pelvis; Peripheral; Race; Reporting; Research Design; Resolution; Retrospective Studies; Risk; Scanning; Shapes; Site; Skeleton; Structure; Surface; Techniques; Thick; Trochanters; Variant; Weight; Woman; X-Ray Computed Tomography; aged; base; bone; bone fragility; bone mass; bone strength; cortex mapping; cortical bone; cost efficient; diabetes control; falls; fracture risk; glycemic control; high risk; hip bone; improved; insight; men; mortality; non-diabetic; novel; prevent; sex; skeletal; soft tissue; substantia spongiosa; trait

PROJECT SUMMARY / ABSTRACT Individuals with type 1 diabetes (T1D) have an increased risk of fracture at any skeletal site, and an alarming 7-fold increased risk of hip fracture compared to non-diabetics, along with worse clinical outcomes after a fracture. However, the mechanisms underlying T1D skeletal fragility are poorly understood, making it difficult to identify those at risk and offer them appropriate interventions to prevent fractures. T1D patients have moderately low DXA-bone mineral density (BMD), which only partially explains their markedly increased risk of fracture. Bone fragility is not only determined by bone mass but also bone size, shape and architecture. Despite the high risk of hip fracture, no studies have assessed 3D distribution of bone density and bone structure at the hip in older adults with T1D, who have the highest risk of fracture. Our goal is to use previously acquired 3D computed tomography (CT) scans of the proximal femur from T1D and non-diabetic controls ≥60 years of age to identify structural and soft tissue deficits that contribute to hip fragility in T1D, as well as gain insight into how T1D characteristics contribute to femoral bone structure and strength. In a retrospective study of older adults with T1D and age-, race- and sex-matched non-diabetic controls who had abdominal or pelvis diagnostic CT scans without contrast, we will assess CT-derived areal BMD (aBMD) and integral, cortical and trabecular volumetric bone density and structure in the proximal femur (Aim 1). Furthermore, we will determine whether older adults with T1D have focal cortical bone defects at the proximal, using a novel technique that maps cortical bone measurements over the surface of the proximal femur to identify localized regions of the hip where T1D and controls differ in cortical bone measures. As hip fracture occurs when loads applied to the hip exceed its strength, we will compare the load-to-strength ratio for hip fracture in T1D versus controls, accounting for subject-specific variation in fall-related impact loads and femoral strength (Aim 2). Finally, we will determine potential contributors to hip fragility, such as glycemic control, microvascular disease and T1D duration (Aim 3). This project will have high impact, as the results will provide novel insights about the underpinnings of hip fragility in T1D that is needed for clinicians to select optimal interventions to reduce hip fractures in this vulnerable patient group.

项目总结/摘要 患有1型糖尿病（T1 D）的个体在任何骨骼部位都具有增加的骨折风险，并且令人担忧的是， 7-与非糖尿病患者相比，髋部骨折的风险增加一倍，沿着更差的临床结局， 骨折然而，T1 D骨骼脆弱性的潜在机制知之甚少，这使得很难 确定那些有风险的人，并为他们提供适当的干预措施，以防止骨折。T1 D患者 中度低DXA骨矿物质密度（BMD），这只能部分解释他们显着增加的风险， 骨折骨脆性不仅取决于骨量，还取决于骨的大小、形状和结构。 尽管髋部骨折的风险很高，但没有研究评估骨密度和骨密度的3D分布。 T1 D老年人的髋关节结构，骨折风险最高。我们的目标是利用以前 对T1 D和≥60岁的非糖尿病对照患者的股骨近端进行3D计算机断层扫描（CT）扫描 岁，以确定导致T1 D髋关节脆性的结构和软组织缺陷，以及获得 深入了解T1 D特征如何影响股骨结构和强度。在一项回顾性研究中 在患有T1 D的老年人和年龄、种族和性别匹配的非糖尿病对照者中， 诊断性CT扫描无造影剂，我们将评估CT衍生的区域BMD（aBMD）和积分，皮质和 股骨近端骨小梁体积骨密度和结构（目标1）。此外，我们将确定 老年T1 D患者是否在近端有局灶性皮质骨缺损，使用一种新的技术， 在股骨近端表面上绘制皮质骨测量值，以识别髋关节的局部区域 其中T1 D和对照组在皮质骨测量方面不同。由于髋部骨折发生时，负荷施加到髋部 超过其强度，我们将比较T1 D与对照组髋部骨折的载荷-强度比， 考虑到跌倒相关冲击载荷和股骨强度的受试者特异性变化（目标2）。最后我们 将确定髋关节脆性的潜在因素，如血糖控制、微血管疾病和T1 D 持续时间（目标3）。该项目将具有很高的影响力，因为其结果将提供有关 T1 D患者髋关节脆性的基础，临床医生需要选择最佳干预措施以减少髋关节 脆弱的患者群体中的骨折。