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Study Finds Areas of Bone Damage in Seniors With Type 2 Diabetes

Mary Caffrey
Authors of the study say the technology exists to screen seniors with type 2 diabetes and identify those at risk of a fracture.
Seniors who develop type 2 diabetes (T2D) are more likely to suffer fractures than those without the disease, and authors of new study say it’s because those with T2D are more likely to have cortical bone damage.

Research in the Journal of Bone and Mineral Research was made possible with imaging called high resolution peripheral quantitative computed tomography, or HR-pQCT, which was developed to track conditions like osteoporosis. They found that while seniors with T2D had normal bone mineral density, they nonetheless suffered 40% to 50% more fractures. Use of HR-pQCT imaging revealed the apparent cause: damage to the cortical bone, the dense outer surface that protects the internal cavity.

“Fracture in older adults with type 2 diabetes is a highly important public health problem and will only increase with the aging of the population and growing epidemic of diabetes,” said Elizabeth Samuelson, MD, lead author of the study, in a statement. “Our findings identify skeletal deficits that may contribute to excess fracture risk in older adults with diabetes and may ultimately lead to new approaches to improve prevention and treatment.”

For the study, researchers evaluated records from 1069 patients in the Framingham Study who were examined between 2005 and 2008 and had HR-pQCT scans in 2012 and 2015. Their average age was 64 years, and 12% had T2D. After adjusting for age, weight, height, and gender, those with T2D had lower cortical volume bone mass density and higher cortical porosity, which means more area was missing bone tissue. This link between T2D and the bone measures did not change between genders or with obesity status. Researchers also found:
  • The cortical mass density and thickness of the radius, a large bone in the forearm, were lower in people with T2D than those without, but only among those who had suffered fracture.
  • Those with higher measures of missing cortical bone in the forearm were higher for T2D patients who had not suffered a fracture.
The researchers wrote, “Findings from this large, community-based study of older adults suggest that modest deterioration in cortical bone and reductions in bone area may characterize diabetic bone disease in older adults.”

Fortunately, the authors conclude, the technology now exists to predict which patients with T2D are at risk for bone fracture, so that steps can be taken to prevent it.


Samelson EJ, Demissie S, Cupples LA, et al. Diabetes and deficits in cortical bone density, microarchitecture, and bone size: Framingham HR-pQCT Study  [published online September 20, 2017]. J Bone Miner Res. doi:10.1002/jbmr.3240

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