Metabolic and bone profile in postmenopausal women with and without type 2 diabetes: a cross-sectional study

Abstract

Introduction. Current studies support the implication of metabolic changes associated with type 2 diabetes in altering bone metabolism, structure and resistance. Objective. We conducted a cross-sectional study on postmenopausal women aimed to analyze the differences in metabolic and bone profile in patients with and without type 2 diabetes Methods. We analyzed the metabolic and bone profile in postmenopausal women with and without type 2 diabetes (T2DM). Clinical, metabolic, hormonal parameters, along with lumbar, hip and femoral bone mineral density (BMD) and trabecular bone score (TBS) were evaluated. Results. 56 women with T2DM(63.57±8.97 years) and 83 non-T2DM (60.21±8.77 years) were included. T2DM patients presented a higher value of body mass index (BMI) and BMD vs. control group (p = 0.001; p = 0.03-lumbar level, p = 0.07-femoral neck and p = 0.001-total hip). Also, BMI correlated positively with lumbar-BMD and glycated hemoglobin (HbA1c) (r = 0.348, p = 0.01; r = 0.269, p = 0.04), correlation maintained even after age and estimated glomerular filtration rate (eGFR) adjustment (r = 0.383, p = 0.005; r = 0.237, p = 0.08). Diabetic patients recorded lower levels of 25(OH)D(p = 0.05), bone markers (p ≤ 0.05) and TBS(p = 0.07). For the entire patient group we found a negative correlation between HbA1c level and bone markers: r = -0.358, p = 0.0005-osteocalcin, r = -0.40, p = 0.0005-P1NP, r = -0.258, p = 0.005-crosslaps. Conclusions. Our results indicate the presence of altered bone microarchitecture in T2DZ patients according to the TBS score, combined with lower levels of bone markers, with a statistically significant negative correlation between HbA1c level and bone markers.

Study of bone turnover markers, procollagen type 1 N-terminal propeptide and osteocalcin in healthy and type 2 diabetes mellitus postmenopausal women

“…In present study the BMI was found to be higher in diabetic group (27.96±4.56) as compared to non-diabetic group (24.45±4.42) (p<0.0001). This is concordance with the study of Dumitru N et al and Nan R et al 15,16 Overweight and obese patients present an increased risk of fracture to minimal trauma. An increased BMI is no longer a protective factor against fragility fractures as it was considered in the past.…”

“…The inhibition of bone formation in T2DM may be due to the accumulation of advanced glycation end-products (AGEs) in the organic bone matrix, which may interfere with normal osteoblast function. 18 [15][16][17]22,23 Lower osteocalcin and P1NP levels found in this study suggest slower bone metabolism with reduced bone formation in postmenopausal type 2 diabetes women as compared to non-T2DM healthy controls. The inhibition of bone formation in T2DM may be due to the accumulation of advanced glycation end-products (AGEs) in the organic bone matrix, which may interfere with normal osteoblast function.…”

“…Similar result was also found in studies of Dumitru N et al, (in postmenopausal T2DM HbA1c% 6.84±1.24 versus non T2DM 5.47±0.31) and Wang et al, (mean HbA1c% in T2DM 9.36±2.35 versus non T2DM 5.67±0.33). 15,17 HbA1c is an indicator of glycemic control. Hyperglycemia results in dysfunction of osteoblasts in diabetic patients.…”

“…21 Dumitru N et al, also highlight the importance of bone quality in postmenopausal type 2 diabetes patients, with a major impact on the fracture risk in these patients. 15 Bone markers in diabetic patients are best indicator of bone quality.…”

“…This study findings are similar to that of the research of Shu et al, (mean P1NP in T2DM 34.3±16 ng/ml versus non T2DM 57.3±28 ng/ml); Raska et al, (mean P1NP in T2DM 39.4±16.7 ng/ml versus non T2DM 45.5±17.3 ng/ml), Wang et al, (mean P1NP in T2DM 48.47±27.27 ng/ml versus non T2DM 65.86±21.06 ng/ml), Dumitru N et al, (mean P1NP in T2DM 41.95±15.50 ng/ml versus non T2DM 58.23±30.09 ng/ml) 15,17,20,21. These studies indicated the presence of low bone turnover markers like P1NP in patients with T2DM, though it is in reference range.…”