title: A bone structural basis for fracture risk in diabetes.
abstract: BACKGROUND
  Elevated areal bone mineral density (aBMD) in type 2 diabetes mellitus is inconsistent with increased fracture risk at some skeletal sites.
  
  
  OBJECTIVE
  Because aBMD is an imperfect surrogate for bone strength, we assessed bone structure and strength more directly using quantitative computed tomography.
  
  
  METHODS
  Diabetic and nondiabetic subjects were evaluated in a cross-sectional study.
  
  
  METHODS
  Subjects were recruited from a random sample of the Rochester, MN, population.
  
  
  METHODS
  Forty-nine subjects (28 women and 21 men) with type 2 diabetes were compared with age- and sex-matched nondiabetic controls.
  
  
  METHODS
  We measured bone geometry, strength, and volumetric BMD (vBMD) at the hip, spine, and wrist, along with hip aBMD, using central and peripheral quantitative computed tomography and estimated bone load to bone strength ratios at each site.
  
  
  RESULTS
  Adjusted for differences in body mass index between cases and controls (29.8 vs. 27.6), hip aBMD was greater in diabetic subjects, but this was accounted for by greater trabecular vBMD. Cortical vBMD was similar in the two groups, as was bone cross-sectional area and cortical thickness. Bone strength measures were generally better in diabetic subjects, but bone loads were higher from their greater weight. Consequently, load to strength ratios (i.e. factor-of-risk) were similar.
  
  
  CONCLUSIONS
  Patients with type 2 diabetes enjoy little benefit from elevated aBMD in terms of improved bone load to strength ratios. With no deficit in bone density, the rationale for antiresorptive therapy in diabetic patients is uncertain, but potential adverse effects of diabetes on bone quality need more study.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA. melton.j@mayo.edu
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: B Lawrence
authors.initials: BL
authors.lastname: Riggs
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Achenbach
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Camp
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bouxsein
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Atkinson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Robb
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000473:pathology; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012306:Risk; D012727:Sex Characteristics; D014057:Tomography, X-Ray Computed; D055815:Young Adult
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