Abstract
Patients with type 2 diabetes (T2DM) are known to have increased risks of femoral neck and vertebral fractures, although their bone mineral density (BMD) is normal or even slightly increased compared to non-DM controls. This observation suggests that bone fragility not reflected by BMD, possibly deterioration of bone quality, may participate in their fracture risks. Quantitative ultrasound (QUS), unlike BMD, could possibly evaluate bone quality, especially the microarchitecture, and therefore may be useful for assessing fracture risk in T2DM. To test this hypothesis, we measured calcaneal QUS as well as BMD at the lumbar spine, femoral neck, and 1/3 radius in 96 women (mean age 66.6 years old) and 99 men (64.7 years old) with T2DM, and examined their associations with prevalent vertebral fractures (VFs). Calcaneal QUS was performed by CM-200 (Elk Corp., Osaka, Japan), and speed of sound (SOS) values were obtained. BMD was measured by QDR4500 (Hologic, Waltham, MA). In T2DM patients, VFs were found in 33 and 45 subjects in women and men, respectively. When compared between subjects with and without VFs, there were no significant differences in values of SOS or BMD at any site between the groups in either gender. The distribution of SOS as a function of age showed that those with VFs were scattered widely, and there were no SOS thresholds for VFs in either gender. Logistic regression analysis adjusted for age and BMI showed that either SOS or BMD was not significantly associated with the presence of VFs in either gender. These results show that QUS as well as BMD are unable to discriminate T2DM patients with prevalent VFs from those without VFs. It seems necessary to seek other imaging modalities or biochemical markers evaluating bone fragility and fracture risk in T2DM.
References
Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505
Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444
Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2009) Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 24:702–709
Anonymous (2001) NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7–29, 2000: highlights of the conference. South Med J 94:569–573
Ashman RB, Corin JD, Turner CH (1987) Elastic properties of cancellous bone: measurement by an ultrasonic technique. J Biomech 20:979–986
Ashman RB, Cowin SC, Van Buskirk WC, Rice JC (1984) A continuous wave technique for the measurement of the elastic properties of cortical bone. J Biomech 17:349–361
Ashman RB, Rho JY, Turner CH (1989) Anatomical variation of orthotropic elastic moduli of the proximal human tibia. J Biomech 22:895–900
Van Buskirk WC, Cowin SC, Ward RN (1981) Ultrasonic measurement of orthotropic elastic constants of bovine femoral bone. J Biomech Eng 103:67–72
Gluer CC, Wu CY, Genant HK (1993) Broadband ultrasound attenuation signals depend on trabecular orientation: an in vitro study. Osteoporos Int 3:185–191
Nicholson PH, Haddaway MJ, Davie MW (1994) The dependence of ultrasonic properties on orientation in human vertebral bone. Phys Med Biol 39:1013–1024
Gluer CC, Wu CY, Jergas M, Goldstein SA, Genant HK (1994) Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 55:46–52
Hans D, Arlot ME, Schott AM, Roux JP, Kotzki PO, Meunier PJ (1995) Do ultrasound measurements on the os calcis reflect more the bone microarchitecture than the bone mass? A two-dimensional histomorphometric study. Bone 16:295–300
Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 11:984–996
Kishimoto H (1997) Examination of the clinical usefulness of new ultrasonic bone density measurement equipment (in Japanese). Osteoporos Jpn 5:815–817
Takaishi Y, Okamoto Y, Ikeo T, Morii H, Takeda M, Hide K, Arai T, Nonaka K (2005) Correlations between periodontitis and loss of mandibular bone in relation to systemic bone changes in postmenopausal Japanese women. Osteoporos Int 16:1875–1882
Vu TT, Nguyen CK, Nguyen TL, Le BM, Le NguyenTrung D, Bui TN, Nakamori M, Kunii D, Sakai T, Yamamoto S (2005) Determining the prevalence of osteoporosis and related factors using quantitative ultrasound in Vietnamese adult women. Am J Epidemiol 161:824–830
CM-100 Multi-Center Study Committee (2003) Normative data and cut-off values for QUS using CM-100 (In Japanese). Osteoporos Jpn 11:129–132
Bauer DC, Gluer CC, Genant HK, Stone K (1995) Quantitative ultrasound and vertebral fracture in postmenopausal women. Fracture Intervention Trial Research Group. J Bone Miner Res 10:353–358
Cepollaro C, Gonnelli S, Pondrelli C, Martini S, Montagnani A, Rossi S, Gennari L, Gennari C (1997) The combined use of ultrasound and densitometry in the prediction of vertebral fracture. Br J Radiol 70:691–696
Hartl F, Tyndall A, Kraenzlin M, Bachmeier C, Guckel C, Senn U, Hans D, Theiler R (2002) Discriminatory ability of quantitative ultrasound parameters and bone mineral density in a population-based sample of postmenopausal women with vertebral fractures: results of the Basel Osteoporosis Study. J Bone Miner Res 17:321–330
Kung AW, Luk KD, Chu LW, Tang GW (1999) Quantitative ultrasound and symptomatic vertebral fracture risk in Chinese women. Osteoporos Int 10:456–461
Ross P, Huang C, Davis J, Imose K, Yates J, Vogel J, Wasnich R (1995) Predicting vertebral deformity using bone densitometry at various skeletal sites and calcaneus ultrasound. Bone 16:325–332
Bauer DC, Ewing SK, Cauley JA, Ensrud KE, Cummings SR, Orwoll ES (2007) Quantitative ultrasound predicts hip and non-spine fracture in men: the MrOS study. Osteoporos Int 18:771–777
Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:629–634
Fujiwara S, Sone T, Yamazaki K, Yoshimura N, Nakatsuka K, Masunari N, Fujita S, Kushida K, Fukunaga M (2005) Heel bone ultrasound predicts non-spine fracture in Japanese men and women. Osteoporos Int 16:2107–2112
Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO, Delmas PD, Pouilles JM, Breart G, Meunier PJ (1996) Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 348:511–514
Huopio J, Kroger H, Honkanen R, Jurvelin J, Saarikoski S, Alhava E (2004) Calcaneal ultrasound predicts early postmenopausal fractures as well as axial BMD. A prospective study of 422 women. Osteoporos Int 15:190–195
Burghardt AJ, Issever AS, Schwartz AV, Davis KA, Masharani U, Majumdar S, Link TM (2010) High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 95:5045–5055
Petit MA, Paudel ML, Taylor BC, Hughes JM, Strotmeyer ES, Schwartz AV, Cauley JA, Zmuda JM, Hoffman AR, Ensrud KE, Osteoporotic Fractures in Men Study Group (2010) Bone mass and strength in older men with type 2 diabetes: the Osteoporotic Fractures in Men Study. J Bone Miner Res 25:285–291
Acknowledgments
This work was supported by a grant from Division of the Heath for the Elderly, Ministry of Health, Labour and Welfare of Japan, and a grant from Mitsui Sumitomo Insurance Welfare Foundation, Japan.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yamaguchi, T., Yamamoto, M., Kanazawa, I. et al. Quantitative ultrasound and vertebral fractures in patients with type 2 diabetes. J Bone Miner Metab 29, 626–632 (2011). https://doi.org/10.1007/s00774-011-0265-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00774-011-0265-9