Comparative Study of Histomorphometric Analysis of Fracture Healing in Controlled Vs Uncontrolled T2DM Patients

Abstract

Introduction: Type 2 Diabetes Mellitus (T2DM) is known to adversely affect bone metabolism and fracture healing. However, the differential impact of glycemic control on histomorphometric and vascular parameters remains underexplored. Aim: To compare fracture healing outcomes in controlled versus uncontrolled T2DM patients using biochemical, histological, and vascular indices.

Methods: A prospective observational study was conducted on 120 patients with long bone fractures, divided into controlled (HbA1c ≤ 7.0%) and uncontrolled (HbA1c ≥ 8.5%) T2DM groups. Serum bone remodeling markers (osteocalcin, P1NP, CTX, ALP, RANKL/OPG), histomorphometric indices (osteoblast/osteoclast surface, mineral apposition rate, bone formation rate), and vascularization parameters (CD31+ vessel density, VEGF expression, perfusion index) were assessed at six weeks post-fracture.

Results: Uncontrolled T2DM patients showed significantly lower osteocalcin, P1NP, and ALP levels, and higher CTX and RANKL/OPG ratios (p<0.001). Histomorphometry revealed reduced osteoblast surface and bone formation rate, with elevated osteoclast activity. Vascularization was markedly impaired, with reduced VEGF expression and perfusion indices in the uncontrolled group.

Conclusion: Poor glycemic control in T2DM patients is associated with delayed and compromised fracture healing. Optimizing metabolic status should be a key component of fracture management in diabetic populations.