Type 2 Diabetes Has Detrimental Effects on Trabecular Bone Quality in Osteoporosis

Osteodensitometry of the hip with an osteoporosis.
Researchers evaluated and compared trabecular bone quality in patients with osteoporosis with and without type 2 diabetes.

The following article is a part of conference coverage from the American Society for Bone and Mineral Research (ASBMR) 2020 Annual Meeting, held virtually from September 11 to 15, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ASBMR 2020 Annual Meeting.


Long-term uncontrolled type 2 diabetes (T2D) has detrimental effects on trabecular bone quality, according to study results presented at the American Society for Bone and Mineral Research (ASBMR) 2020 Annual Meeting, held virtually from September 11 to 15, 2020.

Type 2 diabetes is associated with increased risk for hip fracture, despite normal to high areal bone mineral density (BMD). While the underlying mechanisms of diabetic skeletal fragility are not well understood, previous studies have suggested that the lack of glycemic control for >5 years may have a detrimental effect on bone quality.

The study cohort included 40 patients without diabetes (mean age, 71.2±10.8 y) and 30 with diabetes (mean age, 67.8±9.2 y) for >5 years (mean duration of diabetes, 7.5±2.8 y). Researchers collected bone samples from participants who were undergoing total hip replacement for low-energy hip fractures.

Baseline characteristics were similar between the 2 groups, including areal BMD; however, bone quality parameters were found to be degraded in patients with T2D. Among individuals with vs without T2D, bone volume fraction, apparent- and tissue-level modulus, and hardness were lower.

Additional compositional differences between the groups included lower mineral to matrix ratio, wider mineral crystals, and bone collagen modifications assessed as higher total fluorescent advanced glycation end products and nonenzymatic cross-link ratio, lower enzymatic cross-link ratio, and altered secondary structure. There was a negative correlation between nonenzymatic cross-link ratios and post-yield-strain. Fluorescent advanced glycation end products was also negatively correlated with post-yield strain energy and toughness.

“Our findings provide evidence of the detrimental effects of diabetes on trabecular bone quality at multiple scales due to lack of glycemic control over an extended period (>5 y) and provide new insight on skeletal fragility in individuals with diabetes,” the researchers concluded.

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Sihota P, Yadav RN, Dhaliwal R, et al. Investigation of human trabecular bone quality in osteoporosis with and without type 2 diabetes. Presented at: ASBMR 2020 Virtual Annual Meeting; September 11-15, 2020; Poster #P-040.