title: Diabetes and femoral neck strength: findings from the Hip Strength Across the Menopausal Transition Study.
abstract: BACKGROUND
  Diabetes mellitus is associated with increased hip fracture risk, despite being associated with higher bone mineral density in the femoral neck.
  
  
  OBJECTIVE
  The objective of the study was to test the hypothesis that composite indices of femoral neck strength, which integrate dual-energy x-ray absorptiometry derived femoral neck size, femoral neck areal bone mineral density, and body size and are inversely associated with hip fracture risk, would be lower in diabetics than in nondiabetics and be inversely related to insulin resistance, the primary pathology in type 2 diabetes.
  
  
  METHODS
  This was a cross-sectional analysis.
  
  
  METHODS
  The study consisted of a multisite, multiethnic, community-dwelling sample of 1887 women in pre- or early perimenopause.
  
  
  METHODS
  Composite indices for femoral neck strength in different failure modes (axial compression, bending, and impact) were measured.
  
  
  RESULTS
  Adjusted for age, race/ethnicity, menopausal stage, body mass index, smoking, physical activity, calcium and vitamin D supplementation, and study site, diabetic women had higher femoral neck areal bone mineral density [+0.25 sd, 95% confidence interval (CI) (+0.06, +0.44) sd] but lower composite strength indices [-0.20 sd, 95% CI (-0.38, -0.03) sd for compression, -0.19 sd, 95% CI (-0.38, -0.003) sd for bending, -0.19 sd, 95% CI (-0.37, -0.02) sd for impact] than nondiabetic women. There were graded inverse relationships between homeostasis model-assessed insulin resistance and all three strength indices, adjusted for the same covariates.
  
  
  CONCLUSIONS
  Despite having higher bone density, diabetic women have lower indices of femoral neck strength relative to load, consistent with their documented higher fracture risk. Insulin resistance appears to play an important role in bone strength reduction in diabetes.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. sishii@ucla.edu
authors.forename: Shinya
authors.initials: S
authors.lastname: Ishii
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Crandall
authors.forename: Preethi
authors.initials: P
authors.lastname: Srikanthan
authors.forename: Gail A
authors.initials: GA
authors.lastname: Greendale
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Huang
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Danielson
authors.forename: Arun S
authors.initials: AS
authors.lastname: Karlamangla
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001696:Biomechanical Phenomena; D015519:Bone Density / Q000502:physiology*; D019245:Compressive Strength; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D005272:Femur Neck / Q000000981:diagnostic imaging* / Q000502:physiology*; D006615:Hip / Q000000981:diagnostic imaging; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged
references.citation: Am J Epidemiol. 2007 Sep 1;166(5):495-505
references.pmid: 17575306
references.citation: JAMA. 2011 Jun 1;305(21):2184-92
references.pmid: 21632482
references.citation: Curr Rheumatol Rep. 2010 Jun;12(3):186-91
references.pmid: 20425518
references.citation: Calcif Tissue Int. 2009 Aug;85(2):104-12
references.pmid: 19458885
references.citation: J Bone Miner Res. 2005 Jul;20(7):1185-94
references.pmid: 15940371
references.citation: Osteoporos Int. 2000;11(8):714-20
references.pmid: 11095176
references.citation: Diabetes Care. 2002 Oct;25(10):1749-54
references.pmid: 12351472
references.citation: Osteoporos Int. 2005 Nov;16(11):1330-8
references.pmid: 15928804
references.citation: J Bone Miner Res. 2004 Jul;19(7):1084-91
references.pmid: 15176990
references.citation: Clin Oral Implants Res. 2010 Jul;21(7):673-81
references.pmid: 20465554
references.citation: J Bone Miner Res. 2010 Feb;25(2):285-91
references.pmid: 19594301
references.citation: J Clin Endocrinol Metab. 2008 Mar;93(3):815-22
references.pmid: 18073298
references.citation: Osteoporos Int. 2010 Feb;21(2):195-214
references.pmid: 19760059
references.citation: J Clin Endocrinol Metab. 2008 Mar;93(3):861-8
references.pmid: 18160467
references.citation: J Clin Endocrinol Metab. 2005 Aug;90(8):4836-45
references.pmid: 15840738
references.citation: J Clin Endocrinol Metab. 2001 Jan;86(1):32-8
references.pmid: 11231974
references.citation: Osteoporos Int. 2005 Dec;16(12):1713-20
references.pmid: 15940395
references.citation: Diabetes Care. 2010 Aug;33(8):1766-70
references.pmid: 20504896
references.citation: Osteoporos Int. 2004 Jan;15(1):62-70
references.pmid: 14605798
references.citation: J Clin Endocrinol Metab. 2010 Nov;95(11):5045-55
references.pmid: 20719835
references.citation: JAMA. 2009 Oct 14;302(14):1573-9
references.pmid: 19826027
references.citation: Best Pract Res Clin Rheumatol. 2009 Dec;23(6):741-53
references.pmid: 19945686
references.citation: J Clin Endocrinol Metab. 2008 Dec;93(12):4804-9
references.pmid: 18796521
references.citation: Horm Metab Res. 2010 Oct;42(11):763-8
references.pmid: 20711953
references.citation: Arch Intern Med. 2005 Jul 25;165(14):1612-7
references.pmid: 16043679
references.citation: Diabetes Care. 2010 Jan;33 Suppl 1:S62-9
references.pmid: 20042775
references.citation: Osteoporos Int. 2010 Dec;21(12):2067-74
references.pmid: 20306023
references.citation: J Bone Miner Res. 1993 Oct;8(10):1211-7
references.pmid: 8256658
references.citation: Injury. 2011 Nov;42(11):1313-6
references.pmid: 21489532
references.citation: Osteoporos Int. 2005 Apr;16(4):380-8
references.pmid: 15365695
references.citation: Diabetes Metab Res Rev. 2009 Nov;25(8):768-72
references.pmid: 19877133
references.citation: Osteoporos Int. 2010 Jan;21(1):99-107
references.pmid: 19543766
references.citation: Osteoporos Int. 2012 Apr;23(4):1381-90
references.pmid: 21927926
references.citation: Osteoporos Int. 2007 Apr;18(4):427-44
references.pmid: 17068657
references.citation: Diabetes Care. 2004 Jun;27(6):1487-95
references.pmid: 15161807
references.citation: Calcif Tissue Int. 2010 Oct;87(4):324-32
references.pmid: 20814670
references.citation: Osteoporos Int. 2011 May;22(5):1367-76
references.pmid: 20658126
references.citation: Am J Clin Nutr. 1982 Nov;36(5):936-42
references.pmid: 7137077
references.citation: Osteoporos Int. 2007 Jul;18(7):963-72
references.pmid: 17287908