Trabecular and cortical bone microarchitecture using high-resolution peripheral quantitative computed tomographic imaging in diabetic peripheral neuropathy

Abstract

Context: Type 2 Diabetes Mellitus (T2D) is associated with an increased risk of fragility fracture despite normal areal bone mineral density (BMD). The contribution of diabetic peripheral neuropathy (PN) to volumetric BMD (vBMD) and bone microarchitecture in T2D is not explored.

Objective: To assess vBMD and microarchitectural properties of bone using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients of T2D with or without PN.

Design: This is a cross-sectional study of patients of T2D divided into two groups [patients with T2D without PN (Group A) and T2D with PN (Group B)]. All patients underwent clinical examination, biochemical evaluation, dual-energy X-ray absorptiometry (DXA), and HR-pQCT of the radius and tibia.

Results: A total of 296 patients were included in the study [Group A (n = 98), Group B (n = 198)]. HR-pQCT demonstrated a significant difference in total vBMD[mg/cm³] at tibia (291.6 ± 61.8 vs. 268.2 ± 63.0; p-0.003); cortical vBMD[mg/cm³] at tibia [912.5 (863.3, 962.4) vs. 853.8 (795.3, 913.2) p-0.000], among groups A and B respectively. Among the microarchitecture parameters, there was a significant difference in cortical porosity at the tibia (2.5% ±1.7% vs. 3%±1.7%; p-0.004), trabecular number[mm^-1] at the tibia [1.080 (0.896, 1.237) vs. 1.140 (0.983, 1.286), p-0.045] and trabecular thickness[mm] at the radius [0.228 (0.217, 0.247) Vs. 0.238 (0.224, 0.253); p-0.006], among groups A and B respectively.

Conclusion: Despite comparable areal BMD, T2D patients with PN have diminished vBMD and deteriorated skeletal microarchitecture, compared to those without PN.

Keywords: Bone microarchitecture; Bone mineral density; Bone quality; Charcot's neuroarthropathy; Diabetic neuropathy; High resolution; Peripheral quantitative computed tomography (HR-pQCT).