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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Clinical Diabetes
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1474546
This article is part of the Research Topic The Prevention and Treatment of Diabetic Osteoporosis View all 5 articles

Quantitative Ultrasound Imaging Reveals Distinct Fracture-Associated Differences in Tibial Intracortical Pore Morphology and Viscoelastic Properties in Aged Individuals with and without Diabetes Mellitusan Exploratory Study

Provisionally accepted
Carolin Dehnen Carolin Dehnen 1Angela Galindo Angela Galindo 1Paula Hoff Paula Hoff 2Oliver Palme Oliver Palme 2Lukas Maurer Lukas Maurer 3Kay Raum Kay Raum 1*Edgar Wiebe Edgar Wiebe 4
  • 1 Charité University Medicine Berlin, Berlin, Germany
  • 2 MVZ Endokrinologikum Berlin am Gendarmenmarkt, Berlin, Baden-Württemberg, Germany
  • 3 Department of Endocrinology and Metabolic Diseases, Charité University Medicine Berlin, Berlin, Baden-Württemberg, Germany
  • 4 Department of Rheumatology, Charite University Hospital, Berlin, Baden-Württemberg, Germany

The final, formatted version of the article will be published soon.

    Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder that increases fragility fracture risk. Conventional DXA-based areal bone mineral density (aBMD) assessments often underestimate this risk. Cortical Backscatter (CortBS) ultrasound, a radiation-free technique, non-invasively analyzes cortical bone's viscoelastic and microstructural properties. This study aimed to evaluate CortBS's discriminative performance in DM patients compared to DXA and characterize changes in cortical bone microstructure in Type 1 and Type 2 DM (T1DM, T2DM) patients.Methods: This in-vivo study included 89 DM patients (T1DM = 39, T2DM = 48) and 76 age-and sex-matched controls. DXA measured aBMD, while CortBS measurements were taken at the anteromedial tibia using a medical ultrasound scanner with custom software. Multivariate analysis of variance assessed the impact of DM type on CortBS and DXA measurement results. Partial least squares discriminant analyses with cross-validation were used to compare the discrimination performance for vertebral, non-vertebral, and any fragility fractures, adjusting for gender, age, and anthropometric parameters (weight, height, BMI).Results: Fractures occurred in 8/23 T1DM, 17/18 T2DM, and 16/55 controls. DXA parameters were reduced in fracture patients, with significant diabetes impact. T2DM was associated with altered CortBS parameters, reduced scatterer density, and larger pores. CortBS outperformed DXA in discriminating fracture risk (0.61 ≤ AUC(DXA) ≤ 0.63, 0.68 ≤ AUC(CortBS) ≤ 0.69).Conclusions: Both T1DM and T2DM showed altered bone metabolism, with T2DM linked to impaired tissue formation. CortBS provides insights into pathophysiological changes in diabetic bone and provided superior fracture risk assessment in DM patients compared to DXA.

    Keywords: Bone, Diabetes Mellitus, Fracture, Turnover (TO), Ultrasound -

    Received: 01 Aug 2024; Accepted: 21 Nov 2024.

    Copyright: © 2024 Dehnen, Galindo, Hoff, Palme, Maurer, Raum and Wiebe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kay Raum, Charité University Medicine Berlin, Berlin, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.