Bone Density and Structure in Overweight Men With and Without Diabetes

Abstract

ObjectiveMetabolic syndrome (MetS), type 1 diabetes (T1D), and type 2 diabetes, are associated with an increased risk of fractures; however, the impact of obesity on bone deficits in diabetes is unknown. We aimed to compare markers of bone structure, bone density, and bone turnover in non-diabetic overweight men with MetS and overweight men with T1D or T2D.Methods and Research DesignIn this cross-sectional study we included participants from two previously described study cohorts consisting of participants with diabetes and participants with MetS. Participants underwent dual-energy X-ray absorptiometry measuring areal bone mineral density (aBMD) at the hip and lumbar spine, High Resolution peripheral Quantitative (HRpQCT) scan of the tibia and radius and measurement of circulating bone turnover markers. We compared groups with unpaired t test and performed multiple linear regression with adjustment for age, body mass index, and smoking.ResultsWe included 33 participants with T1D, 25 participants with T2D, and 34 participants with MetS. Bone turnover markers levels were comparable between T1D and MetS. aBMD at the hip was lower in T1D compared to MetS, also after adjustment. P1NP and Osteocalcin levels were lower among individuals with T2D compared to MetS, whereas aBMD were similar between the groups after multiple adjustments. We observed no difference in volumetric BMD at the tibia or radius between MetS and T1D and T2D, respectively. Participants with T2D had a higher trabecular number and lower trabecular separation compared to individuals with MetS at the tibia, which remained signficant after multiple adjustments.ConclusionIn conclusion, we observed no clinically important differences in bone density or structure between men with T2D, T1D, or MetS. However, men with T2D displayed lower bone turnover compared to MetS highlighting that T2D per se and not obesity, is associated with low bone turnover.

Assessment of Total Procollagen Type 1 Intact N-terminal Propeptide, C-telopeptide of type 1 collagen, Bone Mineral Density and its Relationship to Body Mass Index in Men with Type 2 Diabetes

“…The higher mean age among the cases than the controls may be explained by the fact that DM is more prevalent among the older than the younger groups. This study found no significant differences in mean ± SE of the lumbar spine bone mineral density (LSBMD) and T-score between the two groups, which agrees with previous studies (18) and may be due to the patients and controls having similar BMI (19). The LSBMD assessment by DEXA may be normal or high in obese and diabetic patients, which is an artefact that may impede scan interpretation because the large amount of soft tissue can augment the apparent density of bone and obscure bone edges, complicating DEXA data analysis (20).…”

Characteristics of bone metabolism in the male patients with diabetic neuropathy

“…2 T2DM is recognized as one of risk factors for fractures 3 and individuals with T2DM have 69% increased fracture risk than those without diabetes. 4 However, patients with T2DM usually have normal or even higher bone mineral density (BMD) 5 which may be related to their unique bone metabolism. 6 The mechanisms for the increased fracture risk and special bone metabolism of T2DM patients are not fully established, but it is likely to be multifactorial, in which diabetic neuropathy is one of the most important factors.…”

“…2 T2DM is recognized as one of risk factors for fractures 3 and individuals with T2DM have 69% increased fracture risk than those without diabetes. 4 However, patients with T2DM usually have normal or even higher bone mineral density (BMD) 5 which may be related to their unique bone metabolism. 6…”