Bone Quality in Elderly Patients with Type 2 Diabetes Mellitus

Abstract Background: Type 2 Diabetes Mellitus (T2DM) is one of the most common chronic diseases worldwide and it is associated with an increased risk of osteoporosis and fragility fractures. Our purpose was to analyse microstructural and bone mechanics from femoral heads, markers of bone turnover and bone mineral density in T2DM patients with or without recent fragility fractures. To identify the factors that influence this risk and elucidate diabetes-induced alterations in trabecular bone microarchitecture and bone turnover markers. Methods: The studied population consisted of 28 patients, divided in 4 groups: 6 subjects with hip fracture (OP) without T2DM, 8 patients with hip fracture and T2DM (OP-T2DM), 7 patients with osteoarthritis (OA) without T2DM and 7 patients OA and with T2DM (OA-T2DM). Bone markers, bone mineral density, FRAX score, microstructural and bone material strength from femoral heads and were assessed. Results: The group with hip fracture presented lower BMD values ​​than OA (p <0.05). The OP, OP-T2DM and OA-T2DM groups showed a decrease in bone volume fraction (BV/TV); trabecular number (Tb.N); trabecular thickness (Tb.Th) and increase of the structural model index (SMI) and trabecular bone pattern factor (Tb.Pf), as microstructure results and Young's modulus or elastic modulus; toughness; ultimate stress; ultimate load; extrinsic stiffness and work to failure, as biomechanical results, regarding OA patients (p <0.05). Conclusion: Our results show the negative effect of Type 2 Diabetes Mellitus on trabecular bone structure and mechanical properties. These results emphasize the importance of evaluating diabetic bones using not only bone markers and bone mass, but also bone quality parameters. Therefore, diabetes should be included as a risk factor for osteoporotic fracture in daily clinical practice and in the FRAX tool.