Determinants of Low Bone Turnover in Type 2 Diabetes-the Role of PTH

Abstract

Determinants of low bone turnover in type 2 diabetes (T2DM) are poorly understood. To investigate the relationship between markers of bone turnover, glycaemic control, disease duration and calciotropic hormones in T2DM we assessed baseline biochemical data from the DiabOS Study, a prospective multicenter observational cohort study. In a cross-sectional study-design data from 110 postmenopausal women and men aged 50–75 years diagnosed with T2DM for at least 3 years and 92 non-diabetic controls were evaluated. Biochemical markers of bone formation (N-terminal propeptide of type I procollagen [PINP]), bone-specific alkaline phosphatase [BAP]) and resorption (C-terminal cross-linking telopeptide of type I collagen [CTX]), measures of calcium homeostasis (intact parathormone [iPTH], 25-Hydroxyvitamin D, calcium, magnesium) and glycaemic control were assessed. After adjustment for age, gender and body mass index (BMI), patients with T2DM had lower serum levels of PINP (p < 0.001), CTX (p < 0.001), iPTH (p = 0.03) and magnesium (p < 0.001) compared to controls. Serum calcium, creatinine, 25-Hydroxyvitamin D and sclerostin did not differ between both groups. In multivariate linear regression analyses only serum iPTH remained an independent determinant of bone turnover markers in T2DM (PINP: p = 0.02; CTX: p < 0.001 and BAP: p < 0.01), whereas glycated haemoglobin (HbA1c), disease duration, age and BMI were not associated with bone turnover. In conclusion low bone turnover in T2DM is associated with low iPTH. The underlying mechanism remains to be elucidated.

Osteocalcin associates with bone mineral density and VDR gene polymorphisms in type 1 and type 2 diabetes

“…Our study shows that serum levels of OC and P1NP were lower in patients with T2D than in patients with T1D without differences in serum levels of β-CTX between both groups. Also, these results are in accordance previous works [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]. Insulin has an anabolic effect on the bone, so the finding of lower OC in T2D could be related to the insulin resistance which is characteristic of these patients.…”

Effects of metformin on bone mineral density and bone turnover markers: a systematic review and meta-analysis

“…However, more than half of the included data involving PINP and CTX are from population with T2DM in our study. PINP and CTX are both decreased in patient with T2DM 70–72. It should be acknowledged that risk of bias as to population selection is insufficient in our results.…”

La osteocalcina se asocia con la densidad mineral ósea y los polimorfismos del gen VDR en la diabetes tipo 1 y 2

“…Nuestro estudio muestra que los niveles de OC y P1NP eran más bajos en los pacientes con T2D que en los pacientes con T1D, sin diferencias en los niveles de β-CTX entre ambos grupos. Asimismo, estos resultados concuerdan con trabajos previos [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]. La insulina tiene un efecto anabólico sobre el hueso, por lo que el hallazgo de niveles inferiores de OC en la T2D podría estar relacionado con la resistencia a la insulina que caracteriza a este tipo de pacientes.…”