Computed Tomography to Identify Structural Mechanisms of Hip Fragility in T1DM

计算机断层扫描识别 T1DM 髋部脆弱的结构机制

• 批准号: 10037479
• 负责人: Fjola Johannesdottir
• 金额: $ 8.75万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10037479
• 关键词: 3-Dimensional; Abdomen; Accounting; Address; Adult; Affect; Age; Age of Onset; Age-Years; Anterior; Architecture; Area; Biomechanics; Bone Density; Bone Tissue; Bone structure; Characteristics; Clinical; Defect; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Dual-Energy X-Ray Absorptiometry; Elderly; Femur; Fracture; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Height; Hip Fractures; Hip region structure; Hyperglycemia; Incidence; Individual; Inferior; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Lead; Life Expectancy; Measurement; Measures; Mediating; Medical Records; Microvascular Dysfunction; Morbidity - disease rate; Neck; Newly Diagnosed; Outcome; Patients; Pelvis; Peripheral; Race; Reporting; Research Design; Resolution; Retrospective Studies; Risk; Scanning; Shapes; Site; Skeleton; Structure; Surface; Techniques; Thick; Trochanters; Variant; Weight; Woman; X-Ray Computed Tomography; aged; base; bone; bone fragility; bone mass; bone strength; cortex mapping; cortical bone; cost efficient; diabetes control; falls; fracture risk; glycemic control; high risk; hip bone; improved; insight; men; mortality; non-diabetic; novel; prevent; sex; skeletal; soft tissue; substantia spongiosa; trait

PROJECT SUMMARY / ABSTRACT Individuals with type 1 diabetes (T1D) have an increased risk of fracture at any skeletal site, and an alarming 7-fold increased risk of hip fracture compared to non-diabetics, along with worse clinical outcomes after a fracture. However, the mechanisms underlying T1D skeletal fragility are poorly understood, making it difficult to identify those at risk and offer them appropriate interventions to prevent fractures. T1D patients have moderately low DXA-bone mineral density (BMD), which only partially explains their markedly increased risk of fracture. Bone fragility is not only determined by bone mass but also bone size, shape and architecture. Despite the high risk of hip fracture, no studies have assessed 3D distribution of bone density and bone structure at the hip in older adults with T1D, who have the highest risk of fracture. Our goal is to use previously acquired 3D computed tomography (CT) scans of the proximal femur from T1D and non-diabetic controls ≥60 years of age to identify structural and soft tissue deficits that contribute to hip fragility in T1D, as well as gain insight into how T1D characteristics contribute to femoral bone structure and strength. In a retrospective study of older adults with T1D and age-, race- and sex-matched non-diabetic controls who had abdominal or pelvis diagnostic CT scans without contrast, we will assess CT-derived areal BMD (aBMD) and integral, cortical and trabecular volumetric bone density and structure in the proximal femur (Aim 1). Furthermore, we will determine whether older adults with T1D have focal cortical bone defects at the proximal, using a novel technique that maps cortical bone measurements over the surface of the proximal femur to identify localized regions of the hip where T1D and controls differ in cortical bone measures. As hip fracture occurs when loads applied to the hip exceed its strength, we will compare the load-to-strength ratio for hip fracture in T1D versus controls, accounting for subject-specific variation in fall-related impact loads and femoral strength (Aim 2). Finally, we will determine potential contributors to hip fragility, such as glycemic control, microvascular disease and T1D duration (Aim 3). This project will have high impact, as the results will provide novel insights about the underpinnings of hip fragility in T1D that is needed for clinicians to select optimal interventions to reduce hip fractures in this vulnerable patient group.

项目摘要 /摘要 1型糖尿病（T1D）的人在任何骨骼部位都有骨折的风险增加，并且令人震惊 与非糖尿病患者相比 断裂。但是，T1D骨骼脆弱性的机制知之甚少，因此很难 确定有风险的人，并提供适当的干预措施以防止骨折。 T1D患者有 中度低的DXA骨矿物质密度（BMD），仅部分解释了它们明显增加的风险 断裂。骨骼脆弱性不仅取决于骨骼质量，还决定骨骼的大小，形状和建筑。 尽管髋部骨折的风险很高，但尚未评估骨密度和骨骼的3D分布 T1D老年人的臀部结构，骨折风险最高。我们的目标是以前使用 从T1D和非糖尿病对照≥60的股骨近端的3D计算机断层扫描（CT）扫描≥60 鉴定结构和软组织的年龄定义有助于T1D的髋关节脆弱性以及增益 深入了解T1D特征如何有助于股骨结构和强度。在回顾性研究中 患有腹部或骨盆的老年人和年龄，种族和性别匹配的非糖尿病对照的老年人 诊断性CT扫描而无需对比，我们将评估CT衍生的Areal BMD（ABMD）和积分，皮质和 股骨近端的小梁骨密度和结构（AIM 1）。此外，我们将确定 具有T1D的老年人是否使用一种新型技术，是否具有局灶性皮质骨缺损 地图在股骨近端表面上的皮质骨测量值鉴定髋关节的局部区域 在皮质骨测量中，T1D和控制不同的地方。当髋部施加到臀部时，发生髋部骨折 超出其强度，我们将比较T1D与对照组中髋部骨折的负载与强度比， 考虑到与跌落相关的撞击负荷和股骨强度的特定主体变化（AIM 2）。最后，我们 将确定髋关节脆弱性的潜在贡献者，例如血糖控制，微血管疾病和T1D 持续时间（目标3）。该项目将产生很大的影响，因为结果将提供有关该项目的新见解 临床医生选择最佳干预措施以减少髋关节所需的髋关节脆弱性基础 这个脆弱的患者组中的骨折。