Bone mineral density and factors influencing it in Asian Indian population with type 2 diabetes mellitus

Abstract

Objective:To assess bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) patients and its relation, if any, to clinical, hormonal and metabolic factors.Materials and Methods:A prospective evaluation of 194 T2DM patients (97 men and 97 women) was carried out. BMD was done with dual energy X-ray absorptiometry (DXA) at the lumbar spine and total hip. Physical activity, nutritional intake and sunlight exposure were calculated. Biochemical and hormonal tests included serum 25 hydroxy vitamin D [25(OH) D], parathyroid hormone, estrogen, testosterone and urinary calcium-creatinine ratio. Glycosylated hemoglobin and complete lipid profiles were done in patients with diabetes. Five hundred and seventy one non-diabetic controls (262 males and 309 females) were evaluated for BMD alone.Results:BMD was normal (Z score > -2) in 156 (80.5%) and low (Z score ≤ -2) in 38 (19.5%) patients in the diabetes study group. BMD in the diabetes group was significantly higher than the control group in both sexes at the hip and spine. The difference was no longer significant on analysis of a BMI matched control subgroup. Weight and BMI showed significant correlation to BMD. Duration of T2DM, degree of glycemic control, use of drugs like statins and thiazolidinediones, 25(OH) D levels, calcium intake, sunlight exposure and physical activity did not significantly affect BMD in this cohort of individuals with diabetes.Conclusions:Bone mineral density of Asian Indian T2DM subjects was similar to that of healthy volunteers in this study.

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

“…Few authors suggested that women with obesity can lead to lower bone turnover in diabetic women and decreased BMD. 33 Similar gender predilections were shared by other previous authors such as by Dutta et al and Kamalanathan et al 16,10 Out of 113 females, 69 (61.1%) study subjects had attained menopause. These T2DM post-menopausal subjects had less BMD in consistent with findings of Al-Maatouq et al who reported osteopenia (mean T-score= -1.8 SD) in 43.68% patients and osteoporosis (mean T-score= -3.3 SD) in 46.8% (45) patients.…”

“…Most Indian studies reported the magnitude of decreased BMD to be around 16-39% in type 2 DM patients which corroborates with our study. 10 Studies carried out in Western World reported it to be in range of 13% to 46%. 11,12 (Shown in Table no.4).…”

Assessment of osteoporotic alterations in type 2 diabetes: a retrospective study

“…Higher BMD was found among patients with diabetes in studies including both males and females using peripheral and axial DXA simultaneously, 14,41 and hip and lumbar BMD. 42 In contrast, lower BMD values were also found by another study. 35 In the present study, the rationale for assessing both T and Z scores of postmenopausal females was to emphasize the significance of results for patients with diabetes-assessed with Z score, which is appropriate to assess the influence of other metabolic diseases on osteoporosis, 28,43,44 as compared with results from the method generally used for postmenopausal females (T score).…”

Osteoporosis in otherwise healthy patients with type 2 diabetes: A prospective gender based comparative study

“…This is greater compared to finding of Kamalanathan et al . [ 15 ] who reported osteoporosis in 19.5% of patients with T2DM. Osteoporosis prevalence defined by T-score ≤ −2.5 at spine was slightly greater than at hip (33.5% vs. 13.5%, respectively) with a similar trend seen in males (20.4% vs. 7.8%, respectively) and females (47.4% vs. 10.6%, respectively).…”

“…Kamalanathan et al . [ 15 ] also reported no association of testosterone with BMD in a multivariate analysis. Vitamin D deficiency was present in 45.5% patients with no difference in proportion of males and females (44.7% vs. 46.4%, P = 0.806).…”