Association of Bone Metabolic Markers With Diabetic Retinopathy and Diabetic Macular Edema in Elderly Chinese Individuals With Type 2 Diabetes Mellitus

Abstract

Background Diabetic retinopathy (DR) is a common and specific microvascular complication of diabetes. The association of bone metabolic markers with the risk of DR and diabetic macular edema (DME) is unclear. Materials and Methods We investigated the association between bone turnover markers commonly examined in a clinical setting and DR and DME risk in elderly Chinese patients with type 2 diabetes mellitus (T2DM). A total of 408 patients aged 55 to 70 years old with T2DM were included. We first performed univariable logistic regression followed by multivariable logistic regression that included variables selected using purposeful selection. Results Fasting blood glucose (P=0.007) and duration of diabetes (P<0.0001) were significantly associated with DME in multivariable logistic regression; however, the association of β-CTx with DME risk was not statistically significant (P=0.053). Sex-stratified analysis showed that β-CTx was significantly associated with DME only in female subjects (P=0.011). Conclusions β-CTx had no significant association with DR. It was significantly associated with DME in female T2DM patients but not in male T2DM patients. More prospective studies with larger sample sizes are warranted to validate our findings.

Natural history of diabetic macular edema and factors predicting outcomes in sham-treated patients (MEAD study)

“…Consistent with these findings, in a recent study using a health claims database, lipid-lowering medication use was associated with a decreased incidence of DME [6]. Other potential systemic risk factors for DME include age, sleep apnea, pregnancy, anemia, lack of glycemic control, duration of diabetes, nephropathy/microalbuminuria, systemic fluid retention in congestive heart failure or renal disease, and use of the glitazone (thiazolidinedione) class of oral antihyperglycemic medications [7][8][9][10][11].…”

Low serum levels of bone turnover markers are associated with the presence and severity of diabetic retinopathy in patients with type 2 diabetes mellitus

“…In a study that enrolled elderly Chinese patients with T2DM, β-CTX was significantly associated with DME only in females and not related to DR among all individuals. 35 The contradiction might be in part owing to a relatively smaller sample size or varying study population of a wider range of age in the current study. A clinical study documented a positive association between β-CTX and HbA1c in women with normal glucose tolerance, suggesting that bone may serve as a protective compensatory mechanism against subtle increases in HbA1c until the development of diabetes.…”

“…On the contrary, some studies showed that no differences were noted between patients with DR and their controls. 34,35 However, serum P1NP was found to be lower in patients with diabetic macular edema (DME). 35 Nevertheless, we did not find significant differences between mild and severe DR stages.…”

“…BTMs are suggested to be useful indicators in monitoring treatment and diagnosing for secondary causes of osteoporosis 25 as well as independent predictors for osteoporosis [26][27][28] and fracture risk. 29,30 Although there are a number of studies reporting the relationships between bone metabolism, indicated by BTMs, and T2DM, [31][32][33] few studies have focused on the interrelationships between bone biochemical markers and DR, 34,35 in particular, and its severity. Additionally, these researches revealed conflicting and inconclusive results.…”

“…Although there are a number of studies reporting the relationships between bone metabolism, indicated by BTMs, and T2DM, 31‐33 few studies have focused on the interrelationships between bone biochemical markers and DR, 34,35 in particular, and its severity. Additionally, these researches revealed conflicting and inconclusive results.…”