Cortical Bone Porosity of Type-2 Diabetic Postmenopausal Women with Fragility Fractures

Samuel Paran Yap, Thomas Baum, Andrew Burghardt, XiaoJuan Li, Thomas M. Link

Type-2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder that is associated with elevated blood glucose levels attributed to the ineffective use of insulin. It affects more than 200 million people worldwide and is the most common type of diabetes, affecting approximately 90% to 95% of diabetic population. Recent studies have shown that patients with T2DM have an increased risk of fragility fractures of the femur, humerus, spine, and distal portions of the extremities. Currently, fracture risk is assessed via bone mineral density (BMD) measurements from Dual X-ray Absorptiometry (DXA), which indicates if a patient is either osteopenic or
osteoporotic. However, patients with T2DM have elevated BMD measurements with respect to normal controls but have an increased risk of fracture. Our research aims to assess the fracture risk of T2DM patients using a multi-modal approach. We will (1) evaluate the cortical and trabecular micro-architecture of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (hr-pQCT), (2) analyze the bone marrow adiposity using magnetic resonance (MR) spectroscopy, and (3) correlate these findings with standard BMD measurements using DXA and volumetric quantitative computed tomography (QCT).

Figure 1. Representative distal radius (A & C) and ultra-distal tibia (B & D) hr-pQCT images of a normal control without fracture (A & B) and a T2DM patient with fracture (C & D). The cortical porosity of the T2DM patient is higher than that of the control.

Figure 2. MR Spectroscopy comparing normal control without fracture vs. T2DM patient with fracture. T2-weighted fat-saturated fast spin echo sequence shows spectroscopy voxel in L1 and the corresponding fitted spectrum. Green arrow indicates unsaturated lipids and red arrow saturated lipids. Note differences in fat content between the two figures as demonstrated by differences in unsaturated and saturated lipid peaks.

Related Content

MQIR Research Directions