Bone mass and strength in older men with type 2 diabetes: The Osteoporotic Fractures in Men Study

Abstract

The effects of type 2 diabetes mellitus (T2DM) on bone volumetric density, bone geometry, and estimates of bone strength are not well established. We used peripheral quantitative computed tomography (pQCT) to compare tibial and radial bone volumetric density (vBMD, mg/cm3), total (ToA, mm2) and cortical (CoA, mm2) bone area and estimates of bone compressive and bending strength in a subset (n = 1171) of men (≥65 years of age) who participated in the multisite Osteoporotic Fractures in Men (MrOS) study. Analysis of covariance–adjusted bone data for clinic site, age, and limb length (model 1) and further adjusted for body weight (model 2) were used to compare data between participants with (n = 190) and without (n = 981) T2DM. At both the distal tibia and radius, patients with T2DM had greater bone vBMD (+2% to +4%, model 1, p < .05) and a smaller bone area (ToA −1% to −4%, model 2, p < .05). The higher vBMD compensated for lower bone area, resulting in no differences in estimated compressive bone strength at the distal trabecular bone regions. At the mostly cortical bone midshaft sites of the radius and tibia, men with T2DM had lower ToA (−1% to −3%, p < .05), resulting in lower bone bending strength at both sites after adjusting for body weight (−2% to −5%, p < .05) despite the lack of difference in cortical vBMD at these sites. These data demonstrate that older men with T2DM have bone strength that is low relative to body weight at the cortical-rich midshaft of the radius despite no difference in cortical vBMD. © 2010 American Society for Bone and Mineral Research

Osteoporosis in diabetes mellitus: Possible cellular and molecular mechanisms

“…For example, by using DXA Yamaguchi and colleagues demonstrated that, of 187 males with type 2 DM, there was an increase in BMD at the femoral neck with low prevalence of vertebral fracture in diabetic men with metabolic syn dromes [26] . Similarly, Petit and colleagues reported a higher BMD in elderly patients with type 2 DM when compared to agematched nonDM volunteers [27] . In contrast, several other investigators reported a negative effect of type 2 DM on BMD.…”

“…Besides the usual neurovascular complications, both male and female patients with type 1 DM manifest low bone mass at the hip, femoral neck and spine (Table 1), which may eventually lead to an increased incidence of bone fractures [2225,28,29] . In contrast, data on skeletal abnormalities in type 2 DM, or non insulin-dependent DM, appear conflicting, and the exact explanation of this is still unknown [26,27,30] . For example, by using DXA Yamaguchi and colleagues demonstrated that, of 187 males with type 2 DM, there was an increase in BMD at the femoral neck with low prevalence of vertebral fracture in diabetic men with metabolic syn dromes [26] .…”

Osteoporosis risk in Type 2 diabetes patients

“…Strength-to-load ratios (QCT) at the spine and femoral neck were not improved in older adults with diabetes although areal BMD (DXA) was higher [13]. In a study of older men, volumetric BMD (pQCT) was higher, but bone area was smaller at the distal radius and tibia [14]. Smaller cross-sectional area suggests that stimulation of periosteal apposition, normally observed with greater loading, may be reduced in diabetes.…”

Osteoporosis in Diabetics and Its Relation to Igf-1

“…On the other hand, skeletal abnormalities in type 2 DM are confusing as some studies reported a higher bone mass denisity (BMD) in patients with type 2 DM when compared to age-matched non-DM subjects (Petit et al, 2010). In contrast, several other researcher reported a negative effect of type 2 DM on BMD (5).…”