Association of Insulin Glargine Treatment with Bone Mineral Density in Patients with Type 2 Diabetes Mellitus

Abstract

Purpose To assess the association of type 2 diabetes mellitus (T2DM) and insulin glargine treatment with bone mineral density (BMD) in Chinese people. Methods This retrospective study included 50 subjects with T2DM: 25 received oral glucose-lowering medication (ORL group), and 25 received oral glucose-lowering medication in combination with insulin glargine injection (CGI group). Thirty non-diabetic control subjects were also included. BMD was measured at lumbar vertebrae 1–4 (L1–L4), spine bone mineral density (sBMD) results summary (L2–L4), femoral neck and trochanter by dual-energy x-ray absorptiometry. Results Compared with non-diabetic controls, people with T2DM had significantly lower mean BMD at L2 (1.073±0.120 vs 0.984±0.158), L3 (1.094±0.129 vs 0.991±0.163) and L4 (1.089±0.130 vs 0.982±0.165) (all P<0.05), significantly lower levels of serum calcium (2.02±0.22 vs 2.27±0.17 mmol/L, P<0.05), PTH (24.19±9.71 vs 31.52±8.96 pg/mL, P<0.05), and higher serum phosphate levels (1.43±0.37 vs 1.20±0.15 mmol/L, P<0.05). The CGI group had higher L2, L3 and L4 BMD and sBMD (L2–L4) (P<0.05), higher serum calcium levels (2.19±0.11 vs 1.98±0.20 mmol/L, P<0.05) and lower serum phosphate levels (1.28±0.20 vs 1.58±0.43 mmol/L, P<0.05) versus the ORL group. BMD and serum calcium levels were associated with the application of insulin glargine. Conclusion These results suggest that insulin glargine may affect bone metabolism in patients diagnosed with T2DM. The study has implications for the selection of hypoglycemic agents for diabetic patients at risk of osteoporosis.

Comparison of the effect of Dapagliflozin and Pioglitazone on the risk of osteoporosis in postmenopausal women with Type-2 diabetes

“…It is widely accepted that the risk of osteoporosis increases with the prolongation of the duration of DM disease. 20 BMD was reported to decrease with the prolongation of the duration of DM, which was supported by several previous studies. 21 Pathological changes accompanying diabetes are as follows: Decrease in bone collagen, decrease in maturation and transformation of bone matrix, and decrease in BMD value as a result of serum calcium deficiency.…”

“…It was stated that more studies are needed to determine whether there is a relationship between HBA1c and BMD or fracture risk. 20 No significant difference was found between HBA1c and t- scores in our study. It is widely accepted that the risk of osteoporosis increases with the prolongation of the duration of DM disease.…”

The effects of exenatide and insulin glargine treatments on bone turnover markers and bone mineral density in postmenopausal patients with type 2 diabetes mellitus

“…[16] However, in human studies, data on the effect of insulin treatment on bone turnover markers and BMD are conflicting. [17,18] In addition to the known bone effects of diabetes, negative bone remodeling occurs due to hormonal changes caused by menopause, and the risk of osteoporosis and fracture increases rapidly in postmenopausal women. [19] Therefore, the effect of antidiabetic treatment on bone gains importance, especially in this patient group.…”

“…[ 16 ] However, in human studies, data on the effect of insulin treatment on bone turnover markers and BMD are conflicting. [ 17 , 18 ]…”

A Review on the Crosstalk between Insulin and Wnt/β-Catenin Signalling for Bone Health

“…In another study, a positive association was observed between insulin resistance and osteoporosis, whereas a negative relationship was noted between β-cell function and osteoporosis among Taiwanese participants [5]. In patients with type 2 diabetes mellitus (T2DM), those receiving oral glucose-lowering medication and longacting insulin displayed higher spine bone mineral density (BMD) and serum calcium levels compared to those receiving oral glucose-lowering medication only [6]. Rats fed with a high-fat, high-carbohydrate diet displayed insulin resistance and a deterioration of the trabecular bone microstructure [7][8][9][10][11].…”