Hip geometry in diabetic women: implications for fracture risk.
OBJECTIVE
Women with type 2 diabetes mellitus (T2DM) have a higher risk of fractures despite increased bone mineral density (BMD) as compared to women without diabetes. We hypothesized that bone strength is diminished in women with T2DM after accounting for lean body mass, which may contribute to their increased fracture risk.


METHODS
Participants from Women's Health Initiative Observational Study were included in this cross-sectional study. These analyses include 3 groups of women: 1) T2DM women on diet or oral hypoglycemic agents (n=299); 2) T2DM women on insulin therapy (with or without oral agents) (n=128); and 3) Non-diabetic control women (n=5497). Hip structural analyses were done using the validated Beck's method on hip scans from dual energy x-ray absorptiometry (DXA). We compared BMD and section modulus (bending strength) at the narrow neck with and without correcting for total body DXA lean body mass.


RESULTS
Women in all three groups were of similar ages (63.7, 64.6 and 64.2 years, respectively) and heights, but those with T2DM were heavier, with greater lean body weight vs controls (P<.001). In both diabetic groups, absolute BMD and section modulus were higher compared with controls. However, after adjusting for total lean body weight, diabetic women on insulin had significantly lower BMD and section modulus.


CONCLUSIONS
Adjusted for lean body weight, the BMD and bending strength in the femoral neck are significantly lower in insulin-treated diabetic women vs controls. This may represent altered adaptation of bone modeling and explain the higher fracture risk in patients with T2DM.
Brigham and Women's Hospital, Boston, MA 02115, USA.
Rajesh
R
Garg
Zhao
Z
Chen
Thomas
T
Beck
Jane A
JA
Cauley
Guanglin
G
Wu
Dorothy
D
Nelson
Beth
B
Lewis
Andrea
A
LaCroix
Meryl S
MS
LeBoff
D015502:Absorptiometry, Photon; D000368:Aged; D001823:Body Composition; D015519:Bone Density; D016723:Bone Remodeling; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D003927:Diet, Diabetic; D005260:Female; D005265:Femoral Neck Fractures / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D005272:Femur Neck / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008875:Middle Aged; D017698:Postmenopause; D018570:Risk Assessment; D012307:Risk Factors; D013718:Tensile Strength; D016387:Women's Health
D007004:Hypoglycemic Agents