A study of magnitude and correlates of altered bone mineral density in type 2 diabetes mellitus patients of central rural India

Abstract

Background: Diabetes mellitus is fast becoming the epidemic of the 21st century. It is a metabolic disease that affects multiple organ system in the body including bone metabolism and bone mass. There is high prevalence of decreased bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) patients leading to osteoporosis, osteopenia and fracture. The aim of the present study was to find the magnitude and correlates of altered BMD in T2DM patients of central rural India.Methods: This cross-sectional study was carried out at a tertiary care teaching hospital in central rural India from 2014 to 2016. It comprises of 200 T2DM patients with aged ≥35 years. Bone mineral density measurements were done by using peripheral dual energy X-ray absorptiometry (DEXA).Results: Mean age of study subjects was 56.13±11.12 years with 43.5% males and 56.5% females. Our study results showed the magnitude of decreased BMD was 82%. 53% of the study subjects were osteoporotic and 29% were osteopenic. Significant associations were detected between decreased BMD and old age, female gender, high body mass index, high fasting blood sugar, high HbA1c and low serum calcium on multivariate analysis.Conclusions: The prevalence of decreased BMD in patients with T2DM of central rural India is high, especially in females’ patients, obese patients, and uncontrolled diabetic patients. Awareness amongst the health care provider of this changes will directly affect the treatment decisions for patients, thereby preventing osteoporosis, osteopenia and mitigating potential fracture risk.

Osteoporosis Prevalence and Correlates in Uncomplicated Type 2 Diabetes Mellitus

“…Though Prakash et al [10] also reported the prevalence of osteopenia and osteoporosis to be quite high (69.8%), however, in their study the prevalence of osteoporosis was higher (43.8%) as compared to osteopenia (26%). Reema et al 11 reported the overall prevalence of osteopenia and osteoporosis to be close to our study (82% vs 86% in our study), yet in their study proportion of osteoporosis was much higher (53%) than our study (39%) whereas proportion of those with osteopenia was much lower (29%) than our study (47%). These finding suggest that although, there is a high prevalence of osteopenia and osteoporosis in T2DM patients yet the pattern and spectrum of these BMD abnormalities shows a considerable variance.…”

“…Similar to our observations, Sharma et al [6] also found BMD to be lower in females as compared to males. Studies by other workers also supported this observation [10,11].…”

“…We also could not find a significant association between duration of diabetes and BMD status. However, a number of studies found duration of diabetes to be significantly associated with BMD loss [10,11,13,19]. One of the reasons could be primarily the present study had only few cases with T2DM duration >10 years (mean duration of T2DM 6.21 years).…”

“…Secondly, increasing age results in degenerative changes thereby decreasing physical activity [9]. Reema et al [11] in their study observed increasing age to be associated with increased odds of BMD loss in both univariate as well as multivariate analysis. Prakash et al [10] also observed a positive correlation between BMD loss with advancing age.…”

“…Our observations are in contradiction with the observations of Leidig-Bruckner et al [12] and Oei et al [ 18 ] where BMD was positively correlated with BMI. Reema et al [11] and Prakash et al…”