Janina Maria Patsch MD, Presenter: Nothing to Disclose

Thomas Baum, Abstract Co-Author: Nothing to Disclose

Samuel P Yap, Abstract Co-Author: Nothing to Disclose

Xiaojuan Li PhD, Abstract Co-Author: Nothing to Disclose

Dimitrios Karampinos PhD, Abstract Co-Author: Nothing to Disclose

Ann V Schwartz MD, PhD, Abstract Co-Author: Nothing to Disclose

Thomas M. Link MD, PhD, Abstract Co-Author: Consultant, General Electric Company

Diabetic bone disease is associated with major discrepancies between density-based risk assessment and actual fracture incidences. Bone marrow spectroscopy has been shown to be able to discriminate between non-diabetic patients with and without osteoporotic fractures. The aim of this study was to assess bone marrow fat properties of diabetic patients with and without fractures in comparison with normal controls and non-diabetic patients with fragility fractures.

Postmenopausal women (controls n=17; controls with fractures n=15; diabetics without fracture n=15; diabetics with fracture n=7) underwent single-voxel proton MR spectroscopy (1H-MRS) of the lumbar spine (3T, Signa, GE; 4-channel spine coil, GE). A Point Resolved Spectral Selection (PRESS) sequence was used to acquire vertebral body spectra from L1-L3 (TR/TE=3000/37ms, 64 averages without water suppression, sweep width = 5000Hz, data point = 4096, voxel size = 15x15x20mm³ = 4.5cm³ box size). All women had dual-energy x-ray absorptiometry (DXA) scans of the lumbar spine and the hip.  

The total marrow fat content was similar in all four patient groups. However, the amount of unsaturated lipids was significantly reduced in controls with fractures (L2: -25.8%,p=0.047; L3: -25.1%,p= 0.026) and diabetics with fractures (L2: -50.3%,p=0.007; L3: -36%,p=0.045) when compared with non-diabetic controls. We found a similar pattern of unsaturation changes when comparing diabetics with and without fractures (L2: -39.2%;p=0.04; L3: -23.9%;p=0.04). Lipid unsaturation did not differ between the two unfractured groups. Applying the WHO criteria to the mean lumbar spine (L1-L4) and mean total hip bone densities, non-diabetic fracture patients and non-fractured diabetics would have been diagnosed with osteopenia. DXA was unable to detect the true risk profile of fractured diabetics and showed no significant differences between these patients and unfractured controls.  

Bone marrow 1H-MRS seems to be a promising tool for fracture risk assessment irrespective of diabetes history and was superior to DXA in our patient cohort. The metabolic background for decreased marrow lipid unsaturation in fracture patients remains to be elucidated.

Bone marrow spectroscopy may be used as a new biomarker to identify diabetes patients at risk for fracture, which is not possible with DXA-based bone mineral density measurements.

Patsch, J, Baum, T, Yap, S, Li, X, Karampinos, D, Schwartz, A, Link, T, Bone Marrow Spectroscopy Identifies Postmenopausal Patients with Insufficiency Fractures Irrespective of Diabetes History.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008009.html