The increased fracture risk in patients with diabetes is not well understood. Accumulation of advanced glycation end products is one of possible mechanisms for increased bone fragility.
This study has shown that AGEs are higher in the bone of patients with diabetes and that AGEs are inversely correlated with measures of bone fragility as measured by initiation toughness, and thus, confirming previous findings and further establishing AGEs as possible culprit in bone brittleness.
However, in this study, the measures of bone fragility were similar in subjects with and without diabetes and cannot be used to explain the differences in the fracture risk. This study is small in terms of the number of subjects studied, and it seems that patients with diabetes were, for the most part, in very good control of their blood glucose levels. So, the difference in HbA1c levels between two groups is small and could obscure the importance of the role of AGEs in the bone fragility. Comparing the poorly controlled patients with higher HbA1c levels with normal controls may offer better opportunity to document importance of the AGEs for bone fragility, if AGEs are really an important factor. Of course, other factors, such as bone geometry, cortical thickness and bone marrow adiposity can play a role, too.
Another question that needs answering is effect of duration of the diabetes and total glycemic burden (which should be assessed with serial HbA1c measurements) on bone fracture risk and AGEs in the bone.
This study is interesting as it offers another insight into diabetic bone but, at this point, has no clinical utility. The main takeaway point of the study is that we need data on more patients and controls matched by age, weight and sex and stratified by duration of diabetes and by the quality of disease control over time.
Mario Skugor, MD, FACE
Endocrine and Metabolic Institute
Disclosures: Disclosure: Skugor reports no relevant financial disclosures.