title: Increased fracture risk in patients with type 2 diabetes mellitus: an overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools.
abstract: Type 2 diabetes mellitus has recently been linked to an increased fracture risk. Since bone mass seems to be normal to elevated in patient with type 2 diabetes, the increased fracture risk is thought to be due to both an increased falling frequency and decreased bone quality. The increased falling frequency is mainly a result of complications of the disease such as a retinopathy and polyneuropathy. Bone quality is affected through changes in bone shape, bone micro-architecture, and in material properties such as bone mineralization and the quality of collagen. Commonly used methods for predicting fracture risk such as dual energy X-ray absorptiometry and fracture risk assessment tools are helpful in patients with type 2 diabetes mellitus, but underestimate the absolute fracture risk for a given score. New imaging modalities such as high resolution peripheral quantitative computed tomography are promising for giving insight in the complex etiology underlying the fragility of the diabetic bone, as they can give more insight into the microarchitecture and geometry of the bone. We present an overview of the contributing mechanisms to the increased fracture risk and the usefulness of imaging modalities and risk assessment tools in predicting fracture risk in patients with type 2 diabetes.
authors.affiliation: Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: e.dewaard@maastrichtuniversity.nl.
authors.forename: Ellis A C
authors.initials: EA
authors.lastname: de Waard
authors.affiliation: Maastricht University/CAPHRI and NUTRIM, Department of Family Medicine, P.O. Box 616, 6200MD Maastricht, The Netherlands.
authors.forename: Tineke A C M
authors.initials: TA
authors.lastname: van Geel
authors.affiliation: Maastricht University Medical Centre/NUTRIM, Department of Human Movement Science, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Hans H C M
authors.initials: HH
authors.lastname: Savelberg
authors.affiliation: Maastricht University/CAPHRI, Department of Social Medicine, School for Public Health and Primary Care, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
authors.affiliation: Maastricht University Medical Centre/CAPHRI, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium.
authors.forename: Piet P M M
authors.initials: PP
authors.lastname: Geusens
authors.affiliation: Maastricht University Medical Centre/NUTRIM, Department of Internal Medicine, Subdivision of Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, P.O. Box 6, 3590 Diepenbeek, Belgium; VieCuri Medical Centre, Department of Internal Medicine, Subdivision of Endocrinology, P.O. Box 1926, 5900 BX Venlo, The Netherlands.
authors.forename: Joop P W
authors.initials: JP
authors.lastname: van den Bergh
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D003952:Diagnostic Imaging / Q000379:methods*; D005544:Forecasting; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Bone mass; Bone quality; Fall risk; Fractures; Type 2 diabetes mellitus