RESUMEN
In this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites. INTRODUCTION: To examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally-in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters. METHODS: Cross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history. RESULTS: After full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (- 4%) in prediabetes and smaller cross-sectional area of the tibia (- 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (- 5%), cortical thickness (- 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (- 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters. CONCLUSIONS: In this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.
Asunto(s)
Densidad Ósea/fisiología , Diabetes Mellitus Tipo 2/fisiopatología , Hemoglobina Glucada/análisis , Radio (Anatomía)/fisiopatología , Tibia/fisiopatología , Adulto , Anciano , Estudios Transversales , Complicaciones de la Diabetes/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radio (Anatomía)/diagnóstico por imagen , Sistema de Registros , Tibia/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Type 2 diabetes mellitus (T2DM) has been associated with an increased risk of fractures, despite normal to increased bone mineral density (BMD). Insulin use is one of the factors linked to this increased fracture risk. However, direct negative effects of insulin on bone quality are not expected since insulin is thought to be anabolic to bone. In this cross-sectional study the association between insulin use and volumetric BMD (vBMD), bone micro-architecture and bone strength of the distal radius, as measured with HR-pQCT, was examined. Data from 50 participants with T2DM of The Maastricht Study (mean age 62±7.5years, 44% women) was used. Participants were classified as insulin user (n=13) or non-insulin user (n=37) based on prescription data. Linear regression analysis was used to estimate the association between current insulin use and HR-pQCT derived parameters. After adjustment for age, sex, body mass index, glycated hemoglobin A1c and T2DM duration, insulin use was associated with lower total vBMD (standardized beta (ß):-0.56 (95% CI:-0.89 to -0.24)), trabecular vBMD (ß:-0.58 (95% CI:-0.87 to -0.30)), trabecular thickness (ß:-0.55 (95% CI:-0.87 to -0.23)), cortical thickness (ß:-0.41 (95% CI:-0.74 to -0.08)), log cortical pore volume (ß:-0.43 (95% CI:-0.73 to -0.13)), bone stiffness (ß:-0.39 (95% CI:-0.62 to -0.17)) and failure load (ß:-0.39 (95% CI:-0.60 to -0.17)) when compared to the non-insulin users. Insulin use was not associated with cortical vBMD, trabecular number, trabecular separation, cortical porosity and cortical pore diameter. This study indicates that insulin use is negatively associated with bone density, bone micro-architectural and bone strength parameters. These findings may partly explain the previously observed increased fracture risk in insulin users, although there may be residual confounding by other factors related to disease severity in insulin users.
Asunto(s)
Densidad Ósea/fisiología , Diabetes Mellitus Tipo 2/fisiopatología , Fracturas Óseas/fisiopatología , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Análisis de Elementos Finitos , Fracturas Óseas/metabolismo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Knowledge on lower extremity strength is imperative to informed decision making for children with cerebral palsy (CP) with mobility problems. However, a functional and clinically feasible test is not available. We aimed to determine whether the squat test is suitable for this purpose by investigating test performance and execution in children with cerebral palsy and typically developing (TD) peers. METHODS: Squat test performance, defined by the number of two-legged squats until fatigue (max 20), was assessed in twenty children with bilateral CP (6-19years; gross motor function classification system I-III) and sixteen TD children (7-16years). Muscle fatigue was assessed from changes in electromyography (EMG). Joint range-of-motion and net torque were calculated for each single squat, to investigate differences between groups and between the 2nd and last squat. FINDINGS: Fifteen children with CP performed <20 squats (median=13, IQR=7-19), while all TD children performed the maximum of 20 squats. Median EMG frequency decreased and amplitude increased in mm. quadriceps of both groups. Ankle and knee range-of-motion were reduced in children with CP during a single squat by 10 to 15°. No differences between 2nd and last squat were observed, except for knee range-of-motion which increased in TD children and decreased in children with CP. INTERPRETATION: Squat test performance was reduced in children with CP, especially in those with more severe CP. Muscle fatigue was present in both children with CP and TD peers, confirming that endurance of the lower extremity was tested. Minor execution differences between groups suggest that standardized execution is important to avoid compensation strategies. It is concluded that the squat test is feasible to test lower extremity strength in children with CP in a clinically meaningful way. Further clinimetric evaluation is needed before clinical implementation.
Asunto(s)
Parálisis Cerebral/fisiopatología , Prueba de Esfuerzo , Extremidad Inferior/fisiopatología , Músculo Esquelético/fisiopatología , Adolescente , Articulación del Tobillo/fisiología , Articulación del Tobillo/fisiopatología , Estudios de Casos y Controles , Niño , Electromiografía , Femenino , Humanos , Articulación de la Rodilla/fisiología , Articulación de la Rodilla/fisiopatología , Extremidad Inferior/fisiología , Masculino , Fatiga Muscular/fisiología , Músculo Esquelético/fisiología , Músculo Cuádriceps/fisiología , Músculo Cuádriceps/fisiopatología , Rango del Movimiento Articular/fisiología , Torque , Adulto JovenRESUMEN
In this cohort of relatively young and well-treated participants with type 2 diabetes, we found no association between diabetes status and a history of previous fractures and recent falls. Furthermore, no association between diabetes severity and previous fractures or recent falls was found. INTRODUCTION: In this study, we examined the association between glucose metabolism status and historical fractures or recent falls and the effect of diabetes severity (glucose control, insulin use, and diabetes duration) on falls and fractures in the participants with type 2 diabetes. METHODS: Cross-sectional data from 2005 participants of the Maastricht Study. Falls in the past 6 months and fractures ≥age 50 were assessed by questionnaire. Glucose metabolism status (normal glucose metabolism, impaired glucose metabolism, or type 2 diabetes) was based on the oral glucose tolerance test and medication use. RESULTS: In the completely adjusted model, the odds for a fall were not significantly higher in those with impaired glucose metabolism status (OR (95%CI) 1.28 (0.93-1.77)) or with type 2 diabetes (OR (95%CI) 1.21 (0.80-1.81)) compared with the group with normal glucose metabolism. Within the group with type 2 diabetes, there were no significant differences with regard to reported falls between participants with HbA1c >7 % (53 mmol/mol) versus HbA1c ≤7 % (OR (95%CI) 1.05 (0.58-1.90)), insulin users versus non-insulin users (OR (95%CI) 1.51 (0.79-2.89)), and with a diabetes duration >5 versus ≤5 years (OR (95%CI) 0.52 (0.46-1.47)). Similarly, neither glucose metabolism status nor diabetes severity was associated with prior fractures. CONCLUSIONS: Glucose metabolism status was not significantly associated with previous fractures and recent falls. In addition, in this cohort of relatively young and well-treated participants with type 2 diabetes, diabetes severity was not associated with previous fractures and recent falls.
Asunto(s)
Accidentes por Caídas , Glucemia/análisis , Diabetes Mellitus Tipo 2/fisiopatología , Fracturas Óseas/epidemiología , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Fracturas Óseas/complicaciones , Humanos , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
During cavity excavation diagnostic test are used to prevent any unnecessary removal of sound dentine. In this study the validity of a newly introduced blue dye (Quadrant CariTest) was investigated. Twenty-five carious teeth were collected immediately after extraction. The caries lesions were stepwise excavated. From four excavation steps per lesion a digital and an ordinal blue measurement was obtained. From each excavation phase a little amount of excavated dentine was cultured on blood plates. The correlation coefficients between the ordinal and the digital blue measurements and the counts of micro-organisms, expressed in log(CFU)/ml, were respectively 0.56 and 0.45. The sensitivity and the specificity of the ordinal blue measurements were 0.69 and 0.83, those of the digital blue measurements 0.76 and 0.65. The area under ROC of the ordinal blue measurements was 0.77, and that of digital blue measurements 0.70. The areas under ROC were not significantly different (p = 0.14). It was concluded that the new caries indicator is well applicable during the cavity preparation to demonstrate infected dentine.