3D dual-energy x-ray absorptiometry (DEXA) has revealed new insights into the bone health of people with type 2 diabetes, a group in Mexico has reported.
The findings are from a study comparing 3D DEXA scans among 74 patients with type 2 diabetes (T2D) compared with 51 nondiabetic subjects, noted lead author Griselda-Adriana Cruz-Priego, MD, of the National Autonomous University of Mexico in Mexico City, and colleagues.
“Our study highlights the potential of 3D [DEXA] as a valuable tool for analyzing bone quality parameters in patients with T2D, revealing differences in cortical and trabecular bone structure that conventional [bone mineral density] measurements may be unable to detect,” the group wrote. The study was published August 20 in Archives of Medical Research.
The pathophysiology of bone fragility in patients with type 2 diabetes is complex, and while advanced imaging techniques such as quantitative CT (QCT) enable in-depth analyses of bone structure, these techniques are largely limited to research centers, the authors explained.
Conversely, 3D DEXA uses statistical shape and density modeling software (3D-Shaper, 3D Shaper Medical) to reconstruct a 3D representation of the proximal femur from 2D DEXA images. The model estimates parameters such as trabecular bone density, cortical bone thickness, and cortical bone density, and has demonstrated a strong correlation with QCT measurements, the authors noted.
In this study, the group explored the use of 3D DEXA for providing additional insights into bone quality in patients using existing DXA systems without the need for additional imaging modalities.
The researchers recruited 125 participants, including 51 healthy controls and 74 patients with type 2 diabetes, with a predominance of women in both groups (70.3% female). The mean ages were similar (53.9 and 53.6 years old), and the diabetes group had an average disease duration of 11.4 years. The researchers used a Lunar iDXA densitometer (GE HealthCare, or GEHC) to measure bone mineral density (BMD) at the total hip, femoral neck, and lumbar. Then they analyzed the DEXA images with the 3D-Shaper software.
According to the results, standard BMD measurements did not reveal significant differences between the two groups at key sites. However, the 3D analysis revealed significantly lower volumetric BMD in patients with diabetes, particularly in the trochanteric and neck regions, as well as reduced cortical thickness. These differences persisted after adjusting for age, sex, and body mass index, the group noted.
“Although conventional DXA did not detect differences in BMD, the 3D analysis suggests that diabetes may negatively impact bone quality parameters, particularly in the trabecular and cortical compartments of the proximal femur,” the researchers wrote.
Ultimately, the findings could have implications for bone strength and fracture risk, highlighting the need for further research using advanced imaging techniques to better understand the skeletal impact of diabetes, the researchers concluded.
The full study is available here.