Investigation of mechanical, material and compositional determinants of human trabecular bone quality in type 2 diabetes
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Praveer Sihota, Ram Naresh Yadav, Ruban Dhaliwal, Jagadeesh Chandra Bose, Vandana Dhiman, Deepak Neradi, Shailesh Karn, Sidhartha Sharma, Sameer Aggarwal, Vijay G Goni, Vishwajeet Mehandia, Deepak Vashishth (+2 others)
2021
Abstract
Increased bone fragility and reduced energy absorption to fracture associated with type 2 diabetes (T2D) cannot be explained by bone mineral density alone. This study, for the first time reports on alterations in bone tissue's material properties obtained from individuals with diabetes and known fragility fracture status.
To investigate the role of T2D in altering biomechanical, microstructural and compositional properties of bone in individuals with fragility fracture.
Femoral head bone tissue specimens were collected from patients who underwent replacement surgery for fragility hip fracture. Trabecular bone quality parameters were compared in samples of two groups: non-diabetic (n=40) and diabetic (n=30), with a mean duration of disease 7.5±2.8 years.
No significant difference was observed in aBMD between the groups. Bone volume fraction (BV/TV) was lower in the diabetic group due to fewer and thinner trabeculae. The apparent-level toughness and post-yield energy were lower in those with diabetes. Tissue-level (nanoindentation) modulus and hardness were lower in this group. Compositional differences in diabetic group included lower mineral:matrix, wider mineral crystals, and bone collagen modifications - higher total fAGEs, higher non-enzymatic-cross-link-ratio (NE-xLR), and altered secondary structure (Amide bands). There was a strong inverse correlation between NE-xLR and post-yield-strain, fAGEs and post-yield energy, and, fAGEs and toughness.
Current study is novel in examining bone tissue in T2D following first hip fragility fracture. Our findings provide evidence of hyperglycemia's detrimental effects on trabecular bone quality at multiple scales leading to lower energy absorption and toughness-indicative of increased propensity to bone fragility.
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