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1.
J Bone Miner Res ; 2024 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-39151032

RESUMO

Adults with type 1 diabetes (T1D) have increased hip fracture risk, yet no studies have assessed volumetric bone density or structure at the hip in older adults with T1D. Here, we used previously collected 3D CT scans of the proximal femur from older adults with longstanding T1D and non-diabetic controls to identify bone deficits that may contribute to hip fracture in T1D. In this retrospective cohort study, we identified 101 adults with T1D and 181 age-, sex- and race-matched non-diabetic controls (CON) who received abdominal or pelvis CT exams from 2010-2020. Among adults with T1D, 33 (33%) had mild-to-moderate nephropathy, 61 (60%) had neuropathy and 71 (70%) had retinopathy. Within the whole cohort, adults with T1D tended to have lower FN density, though differences did not reach statistical significance. The subset of the T1D group who were diagnosed before age 15 had lower total bone mineral content (-14%, TtBMC), cortical BMC (-19.5%, CtBMC) and smaller Ct cross-sectional area (-12.6, CtCSA) than their matched controls (P<.05 for all). Individuals with T1D who were diagnosed at a later age did not differ from controls in any bone outcome (P>.21). Furthermore, adults with T1D and nephropathy had lower FN aBMD (-10.6%), TtBMC (-17%), CtBMC (-24%) and smaller CtCSA (-15.4%) compared to matched controls (P<.05 for all). Adults with T1D and neuropathy had cortical bone deficits (8.4-12%, P<.04). In summary, among older adults with T1D, those who were diagnosed before age of 15 yrs, those with nephropathy, and those with neuropathy had unfavorable bone outcomes at the FN that may contribute to high hip fracture risk among patients with T1D. These novel observations highlight the longstanding detrimental impact of T1D when present during bone accrual and skeletal fragility as an additional complication of microvascular disease in individuals with T1D.


Older adults with type 1 diabetes (T1D) are at higher risk for hip fractures, but the reasons for this are unclear. In this study, we analyzed existing clinical CT scans of the hip from older adults with longstanding T1D and those without diabetes. While overall bone density differences were not significant, older adults with T1D who were diagnosed before age 15 or had complications like nephropathy or neuropathy showed worse bone outcomes at the femoral neck. These findings suggest that early-onset T1D and related complications contribute to increased hip fracture risk.

2.
Bone ; 181: 117039, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38325649

RESUMO

CONTEXT: People living with spinal cord injury (SCI) are at high risk for bone fractures. Neural, hormonal and metabolic contributors to bone microarchitectural alterations are incompletely understood. OBJECTIVE: To determine the relationship of physical, metabolic and endocrine characteristics with bone microarchitecture, characterized using high-resolution peripheral quantitative computed tomography (HRpQCT) in SCI. DESIGN: Cross-sectional analyses of bone properties in people with SCI. PARTICIPANTS: Twenty adults with SCI and paraplegia (12) or motor incomplete quadriplegia (8). OUTCOME MEASURES: Distal tibia and radius HRpQCT parameters, including density, microstructure and strength by microfinite element anaysis (µFEA); sex hormones; metabolic and inflammatory markers. RESULTS: The mean age of the participants with SCI was 41.5 ± 10.3 years, BMI 25.7 ± 6.2 kg/m2, time since injury 10.4 ± 9.0 years. Participants with SCI had significantly lower median total (Z score - 3.3), trabecular (-2.93), and cortical vBMD (-1.87), and Failure Load by µFEA (-2.48) at the tibia than controls. However, radius vBMD, aBMD and microarchitecture were similar in participants with SCI and un-injured controls. Unexpectedly, C-Reactive Protein (CRP) was positively associated with tibial trabecular vBMD (ß = 0.77, p = 0.02), thickness (ß = 0.52, p = 0.04) and number (ß = 0.92, p = 0.02). At the radius, estradiol level was positively associated with total vBMD (ß = 0.59, p = 0.01), trabecular thickness (ß = 0.43, p = 0.04), cortical thickness (ß = 0.63, p = 0.01) and cortical porosity (ß = 0.74 p = 0.04). CONCLUSIONS: Radius vBMD and microarchitecture is preserved but tibial total, cortical and trabecular vBMD, and estimated bone strength are markedly lower and bone microarchitectural parameters substantially degraded in people with SCI. The alterations in bone microarchitecture in people with SCI are likely multifactorial, however marked degradation of bone microarchitecture in tibia but not radius suggests that unloading is an important contributor of site-specific alterations of bone microarchitecture after SCI. Fracture prevention in SCI should focus on strategies to safely increase bone loading. CLINICALTRIALS: gov registration #: (NCT03576001).


Assuntos
Fraturas Ósseas , Traumatismos da Medula Espinal , Adulto , Humanos , Pessoa de Meia-Idade , Densidade Óssea , Absorciometria de Fóton/métodos , Estudos Transversais , Rádio (Anatomia) , Tíbia/diagnóstico por imagem , Hormônios Esteroides Gonadais
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