{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:02:16Z","timestamp":1791406936752,"version":"4.3.3"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006379","name":"VA Office of Research & Development","doi-asserted-by":"publisher","award":["I01 BX004297"],"award-info":[{"award-number":["I01 BX004297"]}],"id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH\/NIAMS","award":["R01 AR063157"],"award-info":[{"award-number":["R01 AR063157"]}]},{"name":"NIH\/NCRR","award":["S10 RR027631"],"award-info":[{"award-number":["S10 RR027631"]}]},{"DOI":"10.13039\/100000001","name":"NSF","doi-asserted-by":"publisher","award":["2024366680"],"award-info":[{"award-number":["2024366680"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>For a given BMD, adults with type 2 diabetes (T2D) have greater fracture risk than adults without the disease. To test the hypothesis that T2D lowers the fracture resistance of human cortical bone by negatively altering the bone matrix quality, we acquired cadaveric femurs from 120 female and male donors &amp;gt;50\u00a0yr old: 60 without diabetes (Ctrl) and 60 with T2D for \u226510\u00a0yr. We scanned a cross-section from each diaphysis using ex vivo micro-CT (\u03bcCT), followed by cyclic reference point indentation (cRPI: 0-10\u00a0N for 20\u00a0cycles) and impact micro-indentation on the medial surface. From the medial quadrant, a tensile specimen and a single-edge notched beam (SENB) were mechanically tested to assess differences in fracture resistance. Multiple techniques characterized the organic matrix within the SENB. The cortical bone area and thickness of the diaphysis were higher in T2D than in Ctrl. The average creep indentation distance of periosteal bone tissue was significantly lower with T2D suggesting greater resistance to micro-indentation. Bone material strength index trended to be lowering in T2D than in Ctrl but only when the comparison was adjusted for age, sex, and BMI. There were also T2D-related differences in the organic matrix: (1) higher non-enzymatic and mature enzymatic crosslinks, (2) higher fluorescent advanced glycation end-products, and (3) higher thermal stability. Despite these tissue- and molecular-level differences, mechanical properties of cortical bone were similar between the 2 groups. Tensile strength was lower (p\u2009=\u2009.035), while pentosidine was higher (p\u2009=\u2009.006) in donors with CKD than donors without kidney disease, but the difference in strength (p\u2009=\u2009.055) and pentosidine (p\u2009=\u2009.151) were not strictly significant when adjusting for covariates. The elevated fracture risk in T2D may not be a problem of poor mechanical properties of cortical bone, despite alterations in the organic matrix.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf173","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:12:24Z","timestamp":1763644344000},"page":"434-446","source":"Crossref","is-referenced-by-count":3,"title":["Differences and similarities in cortical bone of the femur between donors with and without type 2 diabetes"],"prefix":"10.1093","volume":"41","author":[{"given":"Emily","family":"Berestesky","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]},{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 ,","place":["United 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Society, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2841-5154","authenticated-orcid":false,"given":"David","family":"Lutsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, Health and Society, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 ,","place":["United States"]},{"name":"Department of Medicine, Health and Society, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia M","family":"Hymel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquelyn S","family":"Pennings","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 ,","place":["United States"]},{"name":"Department of Biostatistics , Vanderbilt University Medical Center, Nashville, TN 37203,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Voziyan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2701-6208","authenticated-orcid":false,"given":"Mark D","family":"Does","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]},{"name":"Department of Electrical Engineering and Computer Science, Vanderbilt University , Nashville, TN 37212 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6220-4557","authenticated-orcid":false,"given":"Thomas L","family":"Willett","sequence":"additional","affiliation":[{"name":"Composite Biomaterial Systems Lab, Department of Systems Design Engineering, University of Waterloo , Waterloo, ON N2L 3G1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-7605","authenticated-orcid":false,"given":"Jeffry S","family":"Nyman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University , Nashville, TN 37232 ,","place":["United States"]},{"name":"Department of Orthopaedic Surgery, Vanderbilt University Medical Center , Nashville, TN 37232 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