Diabetes mellitus (DM) significantly impacts bone health. The disease increases fracture risk through distinct alterations in tissue matrix quality and in bone microstructure, but changes are often not adequately reflected in bone mineral density (aBMD measured by DXA). In this cross-sectional study, the authors investigated the discriminative performance of Cortical Backscatter (CortBS) ultrasound in DM patients compared to DXA assessments. CortBS is a radiation-free, non-invasive ultrasound technique that analyzes the viscoelastic and microstructural properties of cortical bone. The study included 89 DM patients (39 with T1DM and 48 with T2DM) and 76 age- and sex-matched controls with and without fractures to characterize changes in cortical bone microstructure in both DM types.
The key findings of this study are:Significant differences were observed: T2DM was associated with larger intracortical pores and reduced scatterer density, while T1DM exhibited unique alterations in pore morphology. CortBS demonstrated significantly better fracture risk discrimination models (AUC 0.66–0.68) compared to aBMD (AUC 0.59–0.63), highlighting its value in identifying structural differences associated with fractures in diabetic populations.
CortBS provides valuable insights into the pathophysiological changes in diabetic bone and offers superior fracture risk assessment in DM patients compared to aBMD. As far as we know, this is the first study to measure intracortical pore diameter morphologies as small as 20 μm in DM patients.
