Skeletal involvement in patients with diabetes mellitus

Carnevale, Vincenzo; Romagnoli, Elisabetta; D'Erasmo, E

doi:10.1002/dmrr.449

Cited by 141 publications

(150 citation statements)

References 114 publications

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“…Subjects reporting diabetes also perceived the lowest rate of change on the GROC (2.33). This finding is in agreement with several studies that reported that diabetes reduces BMD, which puts individuals with diabetes at a higher risk for a slower recovery rate [5,7,29].…”

Section: Discussionsupporting

confidence: 93%

The Impact of Demographic Factors and Comorbidities on Distal Radius Fracture Outcomes

Wilson

Heyde

Sparks

et al. 2013

Hand (New York, N,Y.)

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Background Despite the prevalence and consequences of distal radius fracture (DRF), there is limited research that analyzes the effects of demographic factors and comorbidities as they relate to pain, perceived disability, and functional outcomes. Methods All data for this study were examined retrospectively within an established clinical database. Patients with DRF were evaluated during their first and final visits with a criterion-based numeric pain scale (CR12), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, and a global rate of change scale to assess outcomes of pain, perceived disability, and function, respectively. Results The number of days between injury and initial therapy evaluation were inversely correlated with changes in perceived pain and perceived disability (r =−0.315, p =0.000; r =−0.348, p =0.000). In addition, moderate and statistically significant correlations were noted between work status and average CR12 and DASH scores at final re-evaluation (r =0.392, p =0.000, r =0.473, p =0.000). No significant relationships were noted between additional demographic factors or comorbidities and pain, perceived disability, or function during statistical analysis. Conclusions Patients without diabetes, hypertension, or depression and those who were not smokers had better outcomes in terms of pain, perceived disability, and function in this study. In addition, earlier timing of initial evaluation after injury and full duty work status were significantly related to improvement in pain and perceived disability. Timing of initiation of therapy and return to work are suggested as avenues for future research.Keywords Distal radius fracture . Outcomes . Comorbidities . Demographic factors Distal radius fracture (DRF) can have a severe impact on a person's quality of life by limiting range of motion in the wrist and the ability to complete daily tasks such as dressing, toileting, grooming, and feeding. When a person sustains a DRF, the primary symptoms include edema, pain, and deformity, along with poor range of motion, strength, and dexterity [10]. DRF accounts for one sixth of all fractures in patients over the age of 50 and are the most frequent fractures in the upper limb [1]. Furthermore, up to one fifth of all patients with a DRF have been reported to experience residual symptoms such as pain, nerve symptoms, and disability after 1 year [16]. Despite the prevalence and consequences of this diagnosis, there is limited research that analyzes the effects of demographic factors and comorbidities as they relate to pain, perceived disability, and functional outcomes following DRF.Numerous demographic factors and comorbidities have been previously suggested as intervening variables in the study of fracture outcomes. Gender and age have been identified as variables that may affect the healing process [14,18], while earlier return to function has been correlated with both injury to the dominant hand [2,3] and earlier referral to therapy [27]. Comorbidities including depression, smoking,...

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Section: Discussionsupporting

confidence: 93%

The Impact of Demographic Factors and Comorbidities on Distal Radius Fracture Outcomes

Wilson

Heyde

Sparks

et al. 2013

Hand (New York, N,Y.)

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“…Type I diabetes mellitus negatively alters the mechanical and biologic properties of bone [3,22] and has been associated with an increased risk of complications with fracture healing, including delayed union, wound necrosis, and increased incidence of infection [6,8,23,25,28]. An intervention that would overcome this inhibition of fracture healing would be useful clinically.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these complications result from progressive small vessel arterial disease and peripheral neuropathy that develop with time and are largely untreatable [19,29]. Type I diabetes mellitus alters the mechanical and biologic properties of bone [3,22]. Impairment of histomorphometric, cellular, and biochemical indicators of bone formation, like osteocalcin have been linked to diabetes mellitus [15,27,32].…”

Section: Introductionmentioning

confidence: 99%

Osteogenic Protein-1 Overcomes Inhibition of Fracture Healing in the Diabetic Rat: A Pilot Study

Kidder

Chen

Schmidt

et al. 2008

Clin Orthop Relat Res

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Type I diabetes mellitus inhibits fracture healing and leads to an increase in complications. As a pilot study, we used a closed fracture model in the diabetic rat to address the question of whether osteogenic protein-1 (OP-1) in a collagen carrier can overcome this inhibition by increasing the area of the newly mineralized callus and femoral torque to failure compared with diabetic animals with fractures treated without OP-1. Diabetes was created in 54 rats by injection of streptozotocin. After 2 weeks, a closed femur fracture was created using a drop-weight impaction device. Each fracture site was immediately opened and treated with or without 25 lg OP-1 in a collagen carrier. Animals were euthanized after 2 or 4 weeks. Fracture healing was assessed by callus area from highresolution radiographs, callus strength from torsional failure testing, and undecalcified histologic analysis. The area of newly mineralized callus was greater in diabetic animals treated with 25 lg OP-1/carrier compared with diabetic animals with untreated fractures and with fractures treated with carrier alone. This increase in callus area did not translate into an equivalent increase in torque to failure. Osteogenic protein-1 showed some evidence of overcoming the inhibition of fracture healing in the diabetic rat.

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“…Other parameters may also be affected including AGE-inhibited proliferation and differentiation (33). Although not formally linked, it is possible that problems with fracture repair associated with type 1 diabetes (10,14,41) are directly or indirectly related to the effects of AGEs on osteoblasts. Since enhanced osteoblast apoptosis may represent an important mechanism through which bone formation is limited (19) we investigated the capacity of glycated collagen to stimulate apoptosis of osteoblastic cells and investigated the apoptotic pathways that were stimulated.…”

Section: Introductionmentioning

confidence: 99%

Advanced glycation end products stimulate osteoblast apoptosis via the MAP kinase and cytosolic apoptotic pathways

Alikhani

Boyd

et al. 2007

Bone

319

220

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We have previously shown that diabetes significantly enhances apoptosis of osteoblastic cells in vivo and that the enhanced apoptosis contributes to diabetes impaired new bone formation. A potential mechanism is enhanced apoptosis stimulated by advanced glycation endproducts (AGEs). To investigate this further, an advanced glycation product, carboxymethyl lysine modified collagen (CML-collagen) was injected in vivo and stimulated a 5 fold increase in calvarial periosteal cell apoptosis compared to unmodified collagen. It also induced apoptosis in primary cultures of human or neonatal rat osteoblastic cells or MC-3T3-E1 cells in vitro. Moreover, the apoptotic effect was largely mediated through RAGE receptor. CML-collagen increased p38 and JNK activity 3.2 and 4.4 fold, respectively. Inhibition of p38 and JNK reduced CML-collagen stimulated apoptosis by 45% and 59% and by 90% when used together (P<0.05). The predominant apoptotic pathway induced by CML-collagen involved caspase-8 activation of caspase-3 and was independent of NF-κB activation. When osteoblastic cells were exposed to a long-term low dose incubation with CMLcollagen there was a higher degree of apoptosis compared to short term incubation. In more differentiated osteoblastic cultures apoptosis was enhanced even further. These results indicate that advanced glycation endproducts, which accumulate in diabetic and aged individuals may promote apoptosis of osteoblastic cells and contribute to deficient bone formation.

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Skeletal involvement in patients with diabetes mellitus

Cited by 141 publications

References 114 publications

The Impact of Demographic Factors and Comorbidities on Distal Radius Fracture Outcomes

The Impact of Demographic Factors and Comorbidities on Distal Radius Fracture Outcomes

Osteogenic Protein-1 Overcomes Inhibition of Fracture Healing in the Diabetic Rat: A Pilot Study

Advanced glycation end products stimulate osteoblast apoptosis via the MAP kinase and cytosolic apoptotic pathways

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