Evaluation of bone turnover in postmenopausal patients with type 2 diabetes mellitus using biochemical markers and bone mineral density measurements

Akın, Okhan; Göl, Kemal; Aktürk, Müjde; Erkaya, Salım

doi:10.1080/gye.17.1.19.29

Cited by 73 publications

(43 citation statements)

References 27 publications

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“…However, we observed that patients with type 2 DM with poor metabolic control presented significantly lower osteocalcin levels than normal individuals. These results agree with those reported in other studies, but their significance is not fully understood (24). In other situations in which there is a reduction of osteocalcin levels, both protection (e.g., in obesity) (25,26) and impairment (e.g., in old age) (27)(28)(29) of bone mass have been observed.…”

Section: Discussionsupporting

confidence: 82%

Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

Cutrim¹,

Pereira²,

Paula³

et al. 2007

Braz J Med Biol Res

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We assessed the effect of chronic hyperglycemia on bone mineral density (BMD) and bone remodeling in patients with type 2 diabetes mellitus. We investigated 42 patients with type 2 diabetes under stable control for at least 1 year, 22 of them with good metabolic control (GMC: mean age = 48.8 ± 1.5 years, 11 females) and 20 with poor metabolic control (PMC: mean age = 50.2 ± 1.2 years, 8 females), and 24 normal control individuals (CG: mean age = 46.5 ± 1.1 years, 14 females). We determined BMD in the femoral neck and at the L2-L4 level (DEXA) and serum levels of glucose, total glycated hemoglobin (HbA 1 ), total and ionic calcium, phosphorus, alkaline phosphatase, follicle-stimulating hormone, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OH-D), insulin-like growth factor I (IGFI), osteocalcin, procollagen type I C propeptide, as well as urinary levels of deoxypyridinoline and creatinine. HbA 1 levels were significantly higher in PMC patients (12.5 ± 0.6 vs 7.45 ± 0.2% for GMC and 6.3 ± 0.9% for CG; P < 0.05). There was no difference in 25-OH-D, iPTH or IGFI levels between the three groups. BMD values at L2-L4 (CG = 1.068 ± 0.02 vs GMC = 1.170 ± 0.03 vs PMC = 1.084 ± 0.02 g/cm 2 ) and in the femoral neck (CG = 0.898 ± 0.03 vs GMC = 0.929 ± 0.03 vs PMC = 0.914 ± 0.03 g/cm 2 ) were similar for all groups. PMC presented significantly lower osteocalcin levels than the other two groups, whereas no significant difference in urinary deoxypyridine was observed between groups. The present results demonstrate that hyperglycemia is not associated with increased bone resorption in type 2 diabetes mellitus and that BMD is not altered in type 2 diabetes mellitus.

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Section: Discussionsupporting

confidence: 82%

Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

Cutrim¹,

Pereira²,

Paula³

et al. 2007

Braz J Med Biol Res

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“…The literature on the relationship between biochemical markers of bone turnover and BMD in diabetic and non-diabetic patients suggests that markers of formation and resorption are lower in the diabetic group [14,20], although the study which reported findings in both sexes commented that such differences were apparent in women only [14]. We found no relationship between glucose tolerance and biochemical markers of bone turnover among men in this study, although the numbers studied were small, limiting power.…”

Section: Discussioncontrasting

confidence: 75%

“…While studies of bone density in diabetic patients have given conflicting results, type 2 diabetes is usually associated with increased axial bone density [1,2,3,4,5,6], and it has been suggested that this association is due to insulin resistance. A recent cross-sectional study of over 7500 Canadian men and women showed that type 2 diabetes was associated with higher bone mineral density (BMD) even after adjustment for confounding variables, although relationships were stronger in women [7].…”

Section: Introductionmentioning

confidence: 99%

Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance?

et al. 2004

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Aims/hypothesis. Previous studies have suggested that the high bone density often observed in type 2 diabetic patients may be explained by insulin resistance. We explored this hypothesis in the Hertfordshire Cohort Study. Methods. A total of 465 men and 444 women aged 59 to 71 years and with no prior diagnosis of diabetes attended a clinic where a glucose tolerance test was performed and bone density measured at the femoral neck and lumbar spine. Biochemical markers of bone turnover (serum osteocalcin and urinary mean c-terminal cross-linking telopeptide of type II collagen) were measured in 163 men. Results. According to WHO criteria, 83 men and 134 women were diagnosed with impaired glucose tolerance and a further 33 men and 32 women were diagnosed as having type 2 diabetes. Bone density was higher in newly diagnosed diabetic subjects, with relationships stronger in women (p<0.001) than men (p<0.05) and attenuated by adjustment for body mass index. In both sexes, we observed positive correlations between the total femur and femoral neck bone mineral density with measures of insulin resistance (r=0.17-0.22), with stronger results observed in women. These relationships did not apply after adjustment for body mass index. Glucose status did not lead to differences in osteocalcin level or c-terminal cross-linking telopeptide of type II collagen levels. Conclusions/interpretation. Our findings suggest that hyperinsulinaemia may affect bone mineral density through indirect effects, e.g. body weight.Keywords Bone density · Diabetes · Insulin

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“…However, studies in rodent models of type 2 DM and in rodents fed high-fat diets have demonstrated a reduction in osteoblast recruitment and mineral apposition rate and an increase in osteoclastogenesis, resulting in an imbalance between bone formation and resorption (42,43). Cross-sectional findings in humans further support these data, as serum markers of bone formation, such as osteocalcin, are lower and markers of bone resorption, such as C-terminal telopeptide of type 1 collagen, are elevated in participants with type 2 DM (44,45). Increased bone resorption may be mediated by the formation of advanced glycation end products, which stimulate osteoclast activity and may lead to an uncoupling of bone formation and resorption (46).…”

Section: Pritchard Et Almentioning

confidence: 83%

Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

Pritchard¹,

Giangregorio²,

Atkinson³

et al. 2011

Arthritis Care & Research

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Objective. Adults with type 2 diabetes mellitus (DM) have an elevated fracture risk despite normal areal bone mineral density (aBMD). The study objective was to compare trabecular bone microarchitecture of postmenopausal women with type 2 DM and women without type 2 DM.Methods. An extremity 1T magnetic resonance imaging system was used to acquire axial images (195 ؋ 195 ؋ 1,000 m 3 voxel size) of the distal radius of women recruited from outpatient clinics or by community advertisement. Image segmentation yielded geometric, topologic, and stereologic outcomes, i.e., number and size of trabecular bone network holes (marrow spaces), endosteal area, trabecular bone volume fraction, nodal and branch density, and apparent trabecular thickness, separation, and number. Lumbar spine (LS) and proximal femur BMD were measured with dual x-ray absorptiometry. Microarchitectural differences were assessed using linear regression and adjusted for percent body fat, ethnicity, timed up-and-go test, Charlson Index, and calcium and vitamin D intake; aBMD differences were adjusted for body mass index (BMI). Results. Women with type 2 DM (n ‫؍‬ 30, mean ؎ SD age 71.0 ؎ 4.8 years) had larger holes (؉13.3%; P ‫؍‬ 0.001) within the trabecular bone network than women without type 2 DM (n ‫؍‬ 30, mean ؎ SD age 70.7 ؎ 4.9 years). LS aBMD was greater in women with type 2 DM; however, after adjustment for BMI, LS aBMD did not differ between groups. Conclusion. In women with type 2 DM, the average hole size within the trabecular bone network at the distal radius is greater compared to controls. This may explain the elevated fracture risk in this population.

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Evaluation of bone turnover in postmenopausal patients with type 2 diabetes mellitus using biochemical markers and bone mineral density measurements

Cited by 73 publications

References 27 publications

Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance?

Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls

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