title: [Imaging of diabetic osteopathy].
abstract: OBJECTIVE
  Diabetic bone diseases are more than just osteoporosis in patients with diabetes mellitus (DM): a relatively high bone mineral density is paired with a paradoxically high risk of fragility fractures. Diabetics exhibit low bone turnover, osteocyte dysfunction, relative hypoparathyroidism and an accumulation of advanced glycation end products in the bone matrix. Besides typical insufficiency fractures, diabetics show a high risk for peripheral fractures of the lower extremities (e.g. metatarsal fractures). The correct interdisciplinary assessment of fracture risks in patients with DM is therefore a clinical challenge.
  
  
  METHODS
  There are two state of the art imaging methods for the quantification of fracture risks: dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are suitable for the detection of insufficiency fractures.
  Novel research imaging techniques, such as high-resolution peripheral quantitative computed tomography (HR-pQCT) provide non-invasive insights into bone microarchitecture of the peripheral skeleton. Using MR spectroscopy, bone marrow composition can be studied. Both methods have been shown to be capable of discriminating between type 2 diabetic patients with and without prevalent fragility fractures and thus bear the potential of improving the current standard of care. Currently both methods remain limited to clinical research applications.
  
  
  CONCLUSIONS
  DXA and HR-pQCT are valid tools for the quantification of bone mineral density and assessment of fracture risk in patients with DM, especially if interpreted in the context of clinical risk factors. Radiography, CT and MRI are suitable for the detection of insufficiency fractures.
authors.affiliation: Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-10, 1090, Wien, Österreich, janina.patsch@meduniwien.ac.at.
authors.forename: J
authors.initials: J
authors.lastname: Patsch
authors.forename: P
authors.initials: P
authors.lastname: Pietschmann
authors.forename: C
authors.initials: C
authors.lastname: Schueller-Weidekamm
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D001851:Bone Diseases, Metabolic / Q000175:diagnosis*; D048909:Diabetes Complications / Q000175:diagnosis*; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D061330:Multidetector Computed Tomography / Q000379:methods*