Fractures and Diabetes

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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.

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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.

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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.

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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.

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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.

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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.

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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.