title: Bone marrow fat composition as a novel imaging biomarker in postmenopausal women with prevalent fragility fractures.
abstract: The goal of this magnetic resonance (MR) imaging study was to quantify vertebral bone marrow fat content and composition in diabetic and nondiabetic postmenopausal women with fragility fractures and to compare them with nonfracture controls with and without type 2 diabetes mellitus. Sixty-nine postmenopausal women (mean age 63 ± 5 years) were recruited. Thirty-six patients (47.8%) had spinal and/or peripheral fragility fractures. Seventeen fracture patients were diabetic. Thirty-three women (52.2%) were nonfracture controls. Sixteen women were diabetic nonfracture controls. To quantify vertebral bone marrow fat content and composition, patients underwent MR spectroscopy (MRS) of the lumbar spine at 3 Tesla. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry (DXA) of the hip and lumbar spine (LS) and quantitative computed tomography (QCT) of the LS. To evaluate associations of vertebral marrow fat content and composition with spinal and/or peripheral fragility fractures and diabetes, we used linear regression models adjusted for age, race, and spine volumetric bone mineral density (vBMD) by QCT. At the LS, nondiabetic and diabetic fracture patients had lower vBMD than controls and diabetics without fractures (p = 0.018; p = 0.005). However, areal bone mineral density (aBMD) by DXA did not differ between fracture and nonfracture patients. After adjustment for age, race, and spinal vBMD, the prevalence of fragility fractures was associated with -1.7% lower unsaturation levels (confidence interval [CI] -2.8% to -0.5%, p = 0.005) and +2.9% higher saturation levels (CI 0.5% to 5.3%, p = 0.017). Diabetes was associated with -1.3% (CI -2.3% to -0.2%, p = 0.018) lower unsaturation and +3.3% (CI 1.1% to 5.4%, p = 0.004) higher saturation levels. Diabetics with fractures had the lowest marrow unsaturation and highest saturation. There were no associations of marrow fat content with diabetes or fracture. Our results suggest that altered bone marrow fat composition is linked with fragility fractures and diabetes. MRS of spinal bone marrow fat may therefore serve as a novel tool for BMD-independent fracture risk assessment.
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94107, USA. janina.patsch@ucsf.edu
authors.forename: Janina M
authors.initials: JM
authors.lastname: Patsch
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Li
authors.forename: Thomas
authors.initials: T
authors.lastname: Baum
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Yap
authors.forename: Dimitrios C
authors.initials: DC
authors.lastname: Karampinos
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Link
mesh_terms: D050154:Adiposity; D000818:Animals; D015415:Biomarkers / Q000378:metabolism*; D001853:Bone Marrow / Q000473:pathology*; D003920:Diabetes Mellitus / Q000473:pathology; D003952:Diagnostic Imaging; D004195:Disease Models, Animal; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D051379:Mice; D017698:Postmenopause / Q000378:metabolism*; D015995:Prevalence
chemical_list: D015415:Biomarkers
keywords: BONE MARROW FAT; FRAGILITY FRACTURES; MR SPECTROSCOPY; TYPE 2 DIABETES MELLITUS; UNSATURATION LEVEL
references.citation: Endocrine. 2004 Mar-Apr;23(2-3):183-8
references.pmid: 15146099
references.citation: J Clin Densitom. 2012 Apr-Jun;15(2):224-32
references.pmid: 22169198
references.citation: Eur J Radiol. 2009 Sep;71(3):440-9
references.pmid: 19651482
references.citation: J Nutr Biochem. 2006 Apr;17(4):282-9
references.pmid: 16102959
references.citation: Eur J Clin Nutr. 2012 Apr;66(4):496-503
references.pmid: 22113249
references.citation: J Intern Med. 2012 Oct;272(4):317-29
references.pmid: 22702419
references.citation: Prostaglandins Leukot Essent Fatty Acids. 1994 May;50(5):257-66
references.pmid: 8066101
references.citation: Exp Gerontol. 2002 Jun;37(6):757-67
references.pmid: 12175476
references.citation: J Magn Reson Imaging. 2009 Jun;29(6):1438-42
references.pmid: 19472419
references.citation: Nutrition. 2008 Oct;24(10):1013-22
references.pmid: 18562171
references.citation: Gynecol Endocrinol. 2007 Sep;23(9):535-40
references.pmid: 17852416
references.citation: Am J Clin Nutr. 2011 May;93(5):1142-51
references.pmid: 21367955
references.citation: J Magn Reson Imaging. 2011 Apr;33(4):974-9
references.pmid: 21448966
references.citation: Urology. 2012 Feb;79(2):282-6
references.pmid: 22000931
references.citation: Radiology. 2000 Nov;217(2):527-38
references.pmid: 11058656
references.citation: JAMA. 2011 Jun 1;305(21):2184-92
references.pmid: 21632482
references.citation: Adv Nutr. 2011 Jul;2(4):304-16
references.pmid: 22332072
references.citation: J Magn Reson Imaging. 2012 Jan;35(1):117-24
references.pmid: 22190287
references.citation: Radiology. 2005 Sep;236(3):945-51
references.pmid: 16055699
references.citation: Am J Clin Nutr. 2010 Dec;92(6):1452-60
references.pmid: 20980487
references.citation: Obesity (Silver Spring). 2011 Jan;19(1):49-53
references.pmid: 20467419
references.citation: Clin Geriatr Med. 2008 Aug;24(3):395-405, v
references.pmid: 18672179
references.citation: J Bone Miner Res. 1993 Sep;8(9):1137-48
references.pmid: 8237484
references.citation: Clin Orthop Relat Res. 1971 Oct;80:147-54
references.pmid: 5133320
references.citation: AJNR Am J Neuroradiol. 2001 Sep;22(8):1620-7
references.pmid: 11559519
references.citation: N Engl J Med. 1984 Dec 20;311(25):1601-6
references.pmid: 6504095
references.citation: Mol Cell Biochem. 2012 Jun;365(1-2):343-50
references.pmid: 22411737
references.citation: J Magn Reson Imaging. 2005 Aug;22(2):279-85
references.pmid: 16028245
references.citation: NMR Biomed. 2010 Jun;23(5):466-72
references.pmid: 20099371
references.citation: Magn Reson Med. 2001 Aug;46(2):228-39
references.pmid: 11477625
references.citation: Bone. 2012 Feb;50(2):546-52
references.pmid: 21723971
references.citation: Bone. 2008 Dec;43(6):1115-21
references.pmid: 18793764
references.citation: Curr Rheumatol Rep. 2010 Jun;12(3):163-9
references.pmid: 20425517
references.citation: Aging Cell. 2011 Apr;10(2):191-7
references.pmid: 21210937
references.citation: Am J Clin Nutr. 2005 Apr;81(4):934-8
references.pmid: 15817874
references.citation: AJR Am J Roentgenol. 2004 Dec;183(6):1761-5
references.pmid: 15547224
references.citation: Nat Clin Pract Rheumatol. 2006 Jan;2(1):35-43
references.pmid: 16932650
references.citation: Osteoporos Int. 2007 Apr;18(4):427-44
references.pmid: 17068657
references.citation: Nutr J. 2007 Jan 16;6:2
references.pmid: 17227589
references.citation: Biogerontology. 2001;2(3):165-71
references.pmid: 11708718
references.citation: J Nutr. 2011 Jun;141(6):1146-53
references.pmid: 21508210
references.citation: Bone. 2012 Feb;50(2):534-9
references.pmid: 21757043
references.citation: Magn Reson Imaging. 2008 Feb;26(2):188-97
references.pmid: 17683890