Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies

Dytfeld, Joanna; Michalak, Michał

doi:10.1007/s40520-016-0562-1

Cited by 70 publications

(54 citation statements)

References 45 publications

(68 reference statements)

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“…Meta-analyses have indicated that especially hip fracture risk is increased in T2DM [3, 30] and fractures occur at a higher femoral neck BMD T-score than in non-diabetics [31]. We therefore focused our study of bone density and marrow fat comparisons at both the lumbar spine and femur.…”

Section: Discussionmentioning

confidence: 99%

Marrow adipose tissue composition in adults with morbid obesity

Greenblatt

Eajazi

et al. 2017

Bone

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Patients with type 2 diabetes mellitus (T2DM) have increased fracture risk despite normal or increased bone mineral density (BMD). Elevations in marrow adipose tissue (MAT) and declines in MAT unsaturation are both associated with increased skeletal fragility. The objective of our study was to characterize the quantity and composition of MAT in adults with morbid obesity and T2DM, and to evaluate determinants of MAT. We studied 21 adults with morbid obesity prior to bariatric surgery, 8 of whom had T2DM. All subjects underwent 1H-MR spectroscopy of the lumbar spine and femur for assessment of MAT and dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) of the lumbar spine and hip for assessment of areal BMD (aBMD) and volumetric BMD (vBMD). Visceral (VAT) and subcutaneous adipose tissue (SAT) were quantified by CT at L1-2. Subjects with T2DM had higher vBMD of the femoral neck and higher total MAT at the lumbar spine and femoral metaphysis compared to non-diabetic controls (p≤0.04). Lipid unsaturation index (UI) was significantly lower at the femoral diaphysis in T2DM (p=0.03). Within the entire cohort, HbA1c was positively associated with MAT (p≤0.03), and age was associated with higher MAT and lower MAT unsaturation (p≤0.05). Lumbar spine vBMD was inversely associated with lumbar spine MAT (p=0.04). There was an inverse association between SAT and diaphyseal MAT (p<0.05) while there were no associations with VAT. Subjects with morbid obesity and T2DM have higher MAT with a lower proportion of unsaturated lipids, despite higher femoral neck vBMD. MAT is positively associated with age and HbA1c, and inversely associated with vBMD, suggesting that MAT may serve as an imaging biomarker of skeletal health and metabolic risk.

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Section: Discussionmentioning

confidence: 99%

Marrow adipose tissue composition in adults with morbid obesity

Greenblatt

Eajazi

et al. 2017

Bone

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“…The results of three meta‐analyses of fracture risk associated with T2DM are summarized in Table . All show an increase in hip fracture risk; in addition, increased risk of spine fracture was reported in two studies, and increased risk of foot fracture and wrist fracture was described in the meta‐analysis of Moayeri et al .…”

Section: Epidemiologymentioning

confidence: 99%

Type 2 diabetes mellitus and bone

2018

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Type 2 diabetes (T2DM) is a rapidly growing public health problem. It is associated with an increased risk of fracture, particularly of the hip, despite normal or high bone mineral density. Longer duration of disease and poor glycaemic control are both associated with higher fracture risk. The factors underlying increased fracture risk have not been clearly established, but increased falls risk, obesity, sarcopenia and co‐morbidities are likely to contribute. The basis for reduced bone strength despite higher bone mineral density remains to be fully elucidated. Bone turnover is reduced in individuals with T2DM, with evidence of impaired bone formation. Most studies indicate normal or superior trabecular bone structure although reduced lumbar spine trabecular bone score (TBS) has been reported. Deficits in cortical bone structure have been demonstrated in some, but not all, studies whilst reduced bone material strength index (BMSi), as assessed by microindentation, has been a consistent finding. Accumulation of advanced glycation end products in bone may also contribute to reduced bone strength. The use of FRAX in individuals with T2DM underestimates fracture probability. Clinical management should focus on falls prevention strategies, avoidance of known risk factors, maintenance of good glycaemic control and bone protective intervention in individuals at high risk of fracture. Dietary and surgical strategies to reduce weight have beneficial effects on diabetes but may have adverse effects on skeletal health. Future research priorities include better definition of the mechanisms underlying increased fracture risk in T2DM and optimal strategies for identifying and treating those at high risk.

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“…There is a 1.3-to 2.1-fold increased risk of hip fracture [36,37,39,40] and 1.2-fold increased risk of other fractures [36,37], but vertebral fracture risk does not seem to be increased [37,40] (Table 1). The size of the fracture risk increase may be modest, but it is important to recognise that after fracture, patients with diabetes have greater mortality, develop more complications (such as renal impairment and cardiac problems) and recover less well than non-diabetic patients [41,42].…”

Section: Type 2 Diabetes Fracture and Bmdmentioning

confidence: 99%

“…A number of meta-analyses have reported an increase in the risk of fractures in type 2 diabetes (T2DM) [36][37][38][39][40].…”

Section: Type 2 Diabetes Fracture and Bmdmentioning

confidence: 99%

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

cho¹,

Lee²,

Kang³

2017

Exerc Sci

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clinicians. However, the limited available evidence suggests that osteoporosis treatment does reduce fracture risk in obesity and T2DM with generally similar efficacy to other patients.Keywords Bone · Obesity · Diabetes · Fat · Fracture Obesity, Type 2 Diabetes and BoneObesity is a major and growing public health problem; for example, in the UK, 40% of adults will be obese by 2025 [1]. Obesity is the most important risk factor for type 2 diabetes (T2DM), and the global prevalence of T2DM is likely to be 592 million by 2035 [2]. As the population ages, the burden of osteoporosis and fragility fracture also increases. Obesity and T2DM have effects on fracture risk, and fractures in T2DM are associated with greater morbidity than in the general population. Understanding how to assess and treat fracture risk in these groups is important for health care planning and individual patients. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable in the broader study of osteoporosis, such as the effects of adipokines on bone cells and the effects of collagen glycation on material properties of bone. There are some similarities in the effect of obesity and T2DM on bone, but some important differences such as cortical porosity and collagen glycation.In this review, we describe the effects of obesity and T2DM on fracture risk and discuss possible mechanisms of their effects. We also consider the validity of existing fracture risk prediction tools and efficacy of osteoporosis treatment in these patient groups. AbstractIn an increasingly obese and ageing population, type 2 diabetes (T2DM) and osteoporotic fracture are major public health concerns. Understanding how obesity and type 2 diabetes modulate fracture risk is important to identify and treat people at risk of fracture. Additionally, the study of the mechanisms of action of obesity and T2DM on bone has already offered insights that may be applicable to osteoporosis in the general population. Most available evidence indicates lower risk of proximal femur and vertebral fracture in obese adults. However the risk of some fractures (proximal humerus, femur and ankle) is higher, and a significant number fractures occur in obese people. BMI is positively associated with BMD and the mechanisms of this association in vivo may include increased loading, adipokines such as leptin, and higher aromatase activity. However, some fat depots could have negative effects on bone; cytokines from visceral fat are pro-resorptive and high intramuscular fat content is associated with poorer muscle function, attenuating loading effects and increasing falls risk. T2DM is also associated with higher bone mineral density (BMD), but increased overall and hip fracture risk. There are some similarities between bone in obesity and T2DM, but T2DM seems to have additional harmful effects and emerging evidence suggests that glycation of collagen may be an important factor. Higher BMD but higher fracture risk presents challenges i...

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Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies

Cited by 70 publications

References 45 publications

Marrow adipose tissue composition in adults with morbid obesity

Marrow adipose tissue composition in adults with morbid obesity

Type 2 diabetes mellitus and bone

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

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