Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study.

Abstract

The aim of this study was to determine the association between type-2 diabetes mellitus (DM), BMD and fractures in 6,655 men and women aged 55 years and over from the Rotterdam Study. We compared subjects with type-2 DM to subjects without DM. Additionally, subset analyses were performed, dividing subjects on the basis of the glucose tolerance test into already treated DM, newly diagnosed DM, impaired glucose tolerance (IGT) and normal glucose tolerance (NGT, reference). Femoral neck and lumbar spine BMD were measured using DEXA. Nonvertebral fracture ascertainment was performed using an automated record system involving GPs and local hospitals. Although subjects with DM had higher BMD, they had an increased nonvertebral fracture risk: hazard ratio (HR) 1.33 (1.00-1.77). In subset analysis, the increased fracture risk appeared restricted to treated DM subjects only: HR 1.69 (1.16-2.46). Subjects with IGT had a higher BMD, but contrary to treated DM, they had a lower fracture risk: HR 0.80 (0.63-1.00). In conclusion, subjects with type-2 DM and IGT both have a higher BMD. Whereas, subjects with IGT have a decreased fracture risk, subjects with DM (primarily those with already established and treated DM) had an increased fracture risk, probably due to long-term complications associated with DM.

Low bone mineral density is associated with insulin resistance in bone marrow transplant subjects

“…The Rotterdam study included 792 elderly individuals with type II diabetes mellitus and 5863 non-diabetic controls, and it found a hazard ratio of 1.33 (95% CI 1.00-1.77) for fractures in the diabetic group. 21 In addition, the Rancho Bernardo Study reported that metabolic syndrome was not only associated with a lower BMD, but it was also associated with an increased incidence of osteoporotic fractures. 22 Hyperglycemia may have a direct adverse effect on bone metabolism because glucose enhances osteoclast activity in vitro.…”

Pathophysiological role of enhanced bone marrow adipogenesis in diabetic complications

“…[16][17][18][19][20] Alternatively, analyses of bones of type 2 diabetics have generally observed unchanged or increased bone mineral density, though clinically, both diabetic populations have a substantially increased risk of fractures in comparison to non-diabetics. 18,[21][22][23][24] Additionally, there is increasing evidence that some diabetic medications may negatively impact bone density and marrow adiposity. 1,[25][26][27][28][29] Diabetes also induces microvascular remodeling in the bone marrow manifesting as impaired angiogenic ability, vascular endothelial cell dysfunction, and a reduction in stem cell number.…”

Contribution of methylglyoxal to delayed healing of bone injury in diabetes

“…There is also increasing evidence supporting an association between type 2 diabetes and increased fracture risk (2)(3)(4). The Rotterdam study revealed that individuals with type 2 diabetes had a 69% increased fracture risk compared with those without diabetes, despite having higher BMD (5). In addition, impaired fracture healing is also demonstrated in diabetes (2)(3)(4)6,7).…”