Advanced Imaging Reveals Secrets of Increased Fracture Risk in Diabetes

Photo ID: Thomas Link, M.D.

Thomas Link, M.D., needn’t have worried that he might have to close down an imaging system critical to his work on fragility fractures in people with type 2 diabetes mellitus (T2DM). A grant from the American Recovery and Reinvestment Act (ARRA), has "reinvigorated" his osteoporosis imaging program, allowing him and his team of researchers at the University of California, San Francisco, to better understand why individuals with the T2DM have these fractures, despite the absence of low bone mineral density (BMD). The answer, he says, may be found in bone structure and composition features that his imaging facility identified.

Normal BMD, as measured by a standard imaging procedure called dual x-ray absorptiometry (DXA), does not usually indicate a higher risk for fractures. But when studies showed that women with T2DM had both normal or higher BMD and fractures, Dr. Link decided to investigate further. Using a different imaging modality called high-resolution peripheral quantitative computed tomography (hr-pQCT), he looked at bone structure in a group of elderly women with type 2 diabetes mellitus. This type of imaging system was able to reveal increases in the porosity of cortical bone (an indicator of impaired bone strength) among the T2DM women, as compared with women without the disease. Furthermore, they found a trend toward higher bone marrow fat in the women with diabetes, in particular, in those whose diabetes was not well controlled. Dr. Link now plans to expand his studies and further explore these findings.

Given the project’s success, the scientist is excited about the potential of hr-pQCT to join BMD as a possible bone biomarker for fracture risk. "Finding a strong, noninvasive bone-quality biomarker for fragility fractures in people with diabetes is clearly a major challenge area," says Dr. Link. "Based on our preliminary data, we believe that our novel biomarker may be able to better characterize fracture risk in these patients."

Dr. Link’s ARRA funding, provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, has been a major factor in the success of his work. The support provided a booster for the imaging facility, allowed him to hire two new researchers, sparked additional international funding, and resulted in several new publications. "The ARRA program," he says, "has rescued our significant investment in osteoporosis imaging."

# # #

The activity above is being funded through the American Recovery and Reinvestment Act (ARRA). More information about the National Institutes of Health’s ARRA grant funding opportunities can be found at To track the progress of HHS activities funded through the ARRA, visit To track all federal funds provided through the ARRA, visit

Last Reviewed: