Impact microindentation in men with impaired fasting glucose and type 2 diabetes

Holloway-Kew, Kara L.; Betson, Amelia; Rufus-Membere, Pamela G.; Gaston, James; Diez-Perez, Adolfo; Kotowicz, Mark A.; Pasco, Julie A.

Affiliations

²Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Spain

³Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia

⁴Barwon Health, Geelong, Australia

⁵Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia

Abstract and keywords

Background: Individuals with type 2 diabetes (T2DM) are at increased fracture risk, with bone mineral density (BMD) measurements underestimating risk. Impact microindentation (IMI), a technique that measures bone microindentation distances, expressed as bone material strength index (BMSi), may improve fracture risk estimation in individuals with T2DM. This study describes the relationship between BMSi and glycaemia status in men and makes a comparison with bone measures from dual energy X-ray absorptiometry (DXA).

Material and methods: Participants were 340 men aged 33–96 yr from the Geelong Osteoporosis Study. Impaired fasting glucose (IFG) was defined using fasting plasma glucose (FPG) between 5.5 and 6.9 mmol/L. Diabetes was defined as FPG ≥ 7.0 mmol/L, use of antihyperglycemic medication and/or self-report. Two participants with type 1 diabetes were excluded. BMSi was measured using an OsteoProbe. Femoral neck (FNBMD) and lumbar spine (LSBMD) were measured using DXA (Lunar Prodigy) and trabecular bone score (TBS) was calculated (TBS iNsight Version 2.2).

Using linear regression techniques, the relationship between glycaemia status and BMSi was evaluated, adjusting for other potential confounders (including lifestyle factors, clinical measurements and FNBMD). Glycaemia status was also considered as a binary variable (T2DM vs normoglycaemia and IFG).

Results: There were 234 (68.8%) men with normoglycaemia, 59 (17.4%) with IFG and 47 (13.8%) with diabetes. When considering glycaemia status as a binary variable, men with T2DM had lower mean BMSi compared to those without T2DM (normoglycaemia and IFG combined) (79.8; 95%CI 77.0–82.6 vs 83.0; 82.2–83.8 p = 0.043) and this difference in BMSi was independent of FNBMD. No differences were observed for either FNBMD or LSBMD; however, TBS was lower (1.177; 1.121–1.233 vs 1.256; 1.240–1.272, p = 0.015, independent of FNBMD).

For glycaemia status considered in three groups, there were no differences in mean BMSi values between men with normoglycaemia, IFG and T2DM (82.9 (95%CI 82.0–83.8), 83.5 (81.8–85.2) and 79.8 (77.0–82.6), respectively; ANCOVA, p = 0.104).

Conclusions: Measures reflecting bone material properties and microarchitecture (BMSi and TBS) might be better than measures of bone mass (BMD) in identifying individuals with T2DM at risk of fracture.

Keywords: Impact microindentation; Bone material strength index; Bone mineral density; Trabecular bone score; Impaired fasting glucose; Diabetes; Men

Links

DOI: 10.1016/j.bone.2020.115685

PubMed: 33049369

WoS: 000601336400011

History

Received: 2020-07-30

Revised: 2020-10-7

Accepted: 2020-10-7

Online: 2020-10-10

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2022	Holloway-Kew KL, Rufus-Membere P, Anderson KB, Tembo MC, Sui SX, Hyde NK, Diez-Perez A, Kotowicz MA, Pasco JA. Associations between parameters of peripheral quantitative computed tomography and bone material strength index. Bone. February 2022;155:116268.
2022	Willett TL, Voziyan P, Nyman JS. Causative or associative: a critical review of the role of advanced glycation end-products in bone fragility. Bone. October 2022;163:116485.
2023	Jerban S, Ma Y, Alenezi S, Moazamian D, Athertya J, Jang H, Dorthe E, Dlima D, Woods G, Chung CB, Chang EY, Du J. Ultrashort echo time (UTE) MRI porosity index (PI) and suppression ratio (SR) correlate with the cortical bone microstructural and mechanical properties: ex vivo study. Bone. April 2023;169:116676.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Darelid A, Rudäng R, Sundh D, Litsne H, Johansson L, Lorentzon M. Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women. J Bone Miner Res. June 2023;38(6):860-868.