Bone microarchitecture and strength assessed by HR-pQCT in individuals with type 2 diabetes and prediabetes: the Maastricht study

Abstract

Type 2 Diabetes (T2D) is a prevalent disease and has been associated with an increased fracture risk despite normal or even higher areal bone mineral density (BMD). The aim of this study was to estimate the association between glucose metabolism status (GMS) and measurements of glycemic control with high-resolution peripheral quantitative computed tomography (HR-pQCT) parameters of bone microarchitecture and strength. Participants of The Maastricht Study who underwent a HR-pQCT scan at the distal radius and tibia were included. GMS was determined by use of an oral glucose tolerance test and grouped into a normal glucose metabolism (NGM), prediabetes or T2D. Linear regression models were used, stratified by sex with multiple adjustments. This study incorporated cross-sectional data from 1569 (885 (56.4%) NGM, 251 (16.0%) prediabetes and 433 (27.6%) T2D) men, and 1606 (1159 (72.2%) NGM, 231 (14.4%) prediabetes and 216 (13.4%) T2D) women. The mean age was 60.1 ± 8.6 and 57.8 ± 9.0 years for men and women, respectively. After adjustment, T2D was associated with a higher total BMD measured by HR-pQCT and cortical thickness, and a smaller total and trabecular area in men and women compared to NGM. In women, T2D was additionally associated with a higher stiffness and failure load at the radius. Results were more pronounced at the distal radius than at the distal tibia. To conclude, these findings suggest that in this cohort of Maastricht Study participants, total and trabecular bone area are smaller, but bone microarchitecture, density and bone strength assessed by HR-pQCT are not impaired in individuals with T2D.