Imaging techniques to study diabetic bone disease

Abstract

Purpose of reviewThis review article presents the most recent research on bone fragility in individuals with diabetes from a medical imaging perspective.Recent findingsThe widespread availability of dual-energy X-ray absorptiometry (DXA) and trabecular bone score (TBS) software has led to recent assessments of bone fragility with this texture parameter in several studies of type 2 diabetes mellitus (T2D), but in few of type 1 diabetes mellitus (T1D). Although most studies show a trend of reduced TBS values in T2D independent of areal bone mineral density (aBMD) of the lumbar spine, some studies also show the limitations of TBS in both T2D and T1D. Given the limitations of DXA to assess bone strength and investigate the etiology of bone fragility in diabetes, more investigators are incorporating three-dimensional (3D) medical imaging techniques in their studies. Recent use of 3D medical imaging to assess bone fragility in the setting of diabetes has been mostly limited to a few cross-sectional studies predominantly incorporating high-resolution peripheral quantitative computed tomography (HR-pQCT). Although HR-pQCT studies indicate higher tibial cortical porosity in subjects with T2D, results are inconsistent in T1D due to differences in study designs, sample sizes, and subject characteristics, among other factors. With respect to central CT, recent studies support a previous finding in the literature indicating femoral neck geometrical impairments in subjects with T2D and provide encouraging results for the incorporation of finite element analysis (FEA) to assess bone strength in studies of T2D. In the recent literature, there are no studies assessing bone fragility in T1D with QCT, and only two studies used pQCT reporting tibial and radial impairments in young women and children with T1D, respectively. Magnetic resonance imaging (MRI) has not been recently used in diabetic studies of bone fragility.SummaryAs bone fragility in diabetes is not explained by DXA-derived aBMD and given the limitations of cross-sectional studies, it is imperative to use 3D imaging techniques for longitudinal assessments of the density, quality, and microenvironment of bone to improve our understanding of the effects of diabetes on bone and reduce the risk of fracture in this large and vulnerable population of subjects with diabetes.

Cross-Disciplinary Approach of Adrenal Tumors: Insights into Primary Aldosteronism-Related Mineral Metabolism Status and Osteoporotic Fracture Risk

“…Controversies remain as to whether or not BMD alone is sufficient to adequately assess BMD and predict osteoporotic fracture risk in PA. An interesting observation was the fact that plasma renin activity was inversely correlated with TBS only in females, but not in males, but BMD was not statistically significant different between PA cases and controls in both sexes according to one mentioned study [50]. As a lumbar DXA derivate, we mention that the use of TBS should be particularly encouraged in menopausal women with PA-related glucose profile anomalies [92,93].…”

Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review

“…However, it should be noted that these findings contrast with the data on BMD in type 1 diabetes mellitus (T1DM), in which BMD is typically lower than non-diabetic individuals, with T1DM being traditionally recognized as a cause of secondary osteoporosis with a 6.4-to 6.9-fold increase of fracture risk [84][85][86]. Concerning TBS, some authors showed that controlled T1DM is not correlated with a reduction of TBS [87], while others showed a decreased TBS in T1DM versus non-diabetic controls [88]; TBS was associated with prevalent fractures, but further studies are necessary to pinpoint the exact TBS cutoffs for fracture prediction in T1DM [89,90].…”

Novel techniques for assessment of bone tissue material properties

“…However, the benefit of QCT is that it represents a 3D imaging modality with the ability to differentiate trabecular and cortical bone compartments. Moreover, this imaging modality can generate volumetric bone mineral density assessments [7 ▪ ]. For fracture assessment, QCT can also be used for its ability to assess response of a structure such as bone to a mechanical load, a technique known as finite element analysis (FEA).…”