Can fingernail quality predict bone damage in Type 2 diabetes mellitus? a pilot study

PLoS One. 2021 Sep 30;16(9):e0257955. doi: 10.1371/journal.pone.0257955. eCollection 2021.

Abstract

Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip
  • Case-Control Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / metabolism
  • Female
  • Femoral Neck Fractures / pathology*
  • Femoral Neck Fractures / surgery
  • Femur Neck / chemistry
  • Femur Neck / diagnostic imaging*
  • Femur Neck / pathology
  • Humans
  • Lysine / analogs & derivatives*
  • Lysine / analysis
  • Middle Aged
  • Nails / chemistry
  • Nails / diagnostic imaging*
  • Nails / pathology
  • Osteoporosis, Postmenopausal / diagnostic imaging*
  • Osteoporosis, Postmenopausal / metabolism
  • Osteoporosis, Postmenopausal / pathology
  • Pilot Projects
  • Spectroscopy, Fourier Transform Infrared
  • X-Ray Microtomography

Substances

  • N(6)-carboxymethyllysine
  • Lysine

Grants and funding

The IMP/2019/000150 Impacting Research, Innovation, and Technology (IMPRINT)- Ministry of Human Resource Development (IN) https://imprint-india.org/, CRG/2018/002219 Department of Science & Technology, (IN) https://dst.gov.in, and MoE/STARS-1/632 Ministry of Education, Scheme for Transformational and Advanced Research in Sciences (IN). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.