Fractures and Diabetes

July 10, 2015

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/","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.

Click here to learn more.

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.

Click here to learn more.

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.

Click here to learn more.

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.

Click here to learn more.

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.

Click here to learn more.

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.