Fractures and Diabetes
The following studies highlight recent findings in fracture screening, fracture healing, and possible fracture prevention in T2DM patients.
[[{"type":"media","view_mode":"media_crop","fid":"39465","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_8674149007274","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3958","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 233px; height: 204px; float: right;","title":"© Waldru/Shutterstock.com","typeof":"foaf:Image"}}]]Bone ultrasound appears to be a promising screening method for fracture risk in patients with type 2 diabetes and may be a better predictor of fracture risk than X-ray bone densiometry. Treatment with bone marrow-derived stem cells may become an effective strategy for slow-healing bone fractures in diabetes patients. Treatment with the glucagon-like peptide 1 receptor agonist liraglutide increases bone formation and prevents bone loss in weight-reduced obese women.
Ultrasound Screening for Osteoporotic Fractures in Diabetes
• Diabetes patients typically have higher bone density and are at greater risk for fracture.
• X-ray bone densiometry fails to predict osteoporotic fracture risk accurately in these patients.
• These researchers set out to evaluate the risk of osteoporotic fracture using ultrasound of the calcaneal bone in patients with type 2 diabetes (see abstract 517). The study included 108 consecutive patients with diabetes (55 men, 53 women) and 287 healthy controls matched for age and sex.
Lower T-scores for Diabetes Patients with Fractures
• Patients with diabetes showed lower T-scores than healthy controls and a higher BMI.
• All bone ultrasound parameters, including T-score, were lower for those who had diabetes and fractures compared with patients with diabetes who did not have fractures.
• The researchers concluded that ultrasound of the heel appears to be a promising method for screening for fracture risk in patients with type 2 diabetes.
Click here for the next study.
Stem Cells to Support Fracture Repair
• Fractures in diabetic patients are slower to heal and have an increased risk for developing malunion in comparison to fractures in those without diabetes.
• The etiology of diabetic fracture malunion may be dysregulated progenitor function.
• These researchers investigated the therapeutic efficacy of locally administered non-diabetic human bone marrow-derived mesenchymal stem cells to support femoral fracture repair in a murine model of diabetes.
Stem Cells Enhance Bone Remodeling
• In this 56-day, dose-escalation study, stem cells were administered locally to femoral fractures, and mice were evaluated weekly.
• Micro-computed tomography analysis revealed an increase in bone volume, along with a statistically significant decrease in the ratio of bone surface area to bone volume, in mice treated with stem cells as compared with control mice treated with saline.
• Treatment of the diabetic fracture with stem cells resulted in enhanced mechanical integrity of the repaired bone.
• The researchers concluded that local administration of non-diabetic stem cells to diabetic fractures has the potential to enhance callus remodeling, resulting in the deposition of higher quality reparative bone.
Click here for the next study.
GLP-1 Agonists Play a Role in Bone Formation
• Glucagon-like peptide 1 (GLP-1) regulates bone turnover.
• These researchers set out to investigate the role of GLP-1 receptor agonists on bone formation and bone mass reductions after weight loss.
• The randomized, controlled study included 37 healthy obese women, median age 46, with mean BMI of 34±0.5 kg/m2.
Liraglutide Preserves Bone After Weight Loss
• After a low-calorie diet-induced 12% weight loss, participants were randomized to treatment with or without 1.2 mg per day of liraglutide for 52 weeks.
• Total and arm-leg bone mineral content loss was 4 times greater in the control group as compared to the liraglutide group.
• The bone formation marker P1NP increased by 16% in the liraglutide group and decreased by 2% in the control group.
• The results support the role of treatment with liraglutide to preserve bone after weight loss.
Take-home Messages
• Bone ultrasound may provide better results than X-ray bone densiometry to predict the risk of osteoporotic fracture in patients with type 2 diabetes.
• Stem cells hold the potential to improve the treatment and lessen the pain and discomfort of diabetic patients with fractures.
• Treatment with the long-acting GLP-1 receptor agonist liraglutide can increase bone formation and prevent bone loss after weight loss obtained through a low calorie-diet.
