Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus

Jiajue, Ruizhi; Jiang, Yan; Wang, O.; Li, M.; Xing, Xiaoping; Cui, Lijia; Yin, Jian; Xu, Li; Xia, Weibo

doi:10.1007/s00198-014-2714-5

Cited by 71 publications

(59 citation statements)

References 28 publications

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“…Two studies have reported increased prevalence of vertebral fractures [30,31], while two others found no evidence of an association [32,33]. Interestingly, a recent study among postmenopausal women in Beijing found no overall association between diabetes and prevalence of morphometric vertebral fracture (OR = 1.04: 0.58-1.88), but did find increased prevalence with diabetes when only non-obese (BMI b 25 kg/m 2 ) women were considered (OR = 2.79; 1.16-6.68) [34].…”

Section: Increased Incidence Of Non-vertebral Fracture With Type 2 DImentioning

confidence: 87%

“…Among obese women, BMD was higher but not statistically different between those with and without DM. However, the Peking Vertebral Fracture Study among women in Beijing found higher spine BMD with DM among the non-obese and no difference by diabetes status in the obese women [34]. A recent study in the U.S., using high resolution pQCT rather than DXA, found evidence of reduced cortical bone density and thickness with greater cortical porosity, in non-obese T2D women compared with controls or with obese T2D women [57].…”

Section: Bone Density Is Higher With Diabetesmentioning

confidence: 98%

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Epidemiology of fractures in type 2 diabetes

Schwartz

2016

Bone

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Section: Increased Incidence Of Non-vertebral Fracture With Type 2 DImentioning

confidence: 87%

Section: Bone Density Is Higher With Diabetesmentioning

confidence: 98%

Epidemiology of fractures in type 2 diabetes

Schwartz

2016

Bone

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“…This would predominantly be expected to be a factor in type 2 diabetes. It would by nature lead to a low turnover state in the bones, which is what is seen in diabetes [2,3]. 2.…”

mentioning

confidence: 99%

“…Decreased bone turnover resulting from decreased osteoclastic resorption in bone with glycated collagen [2,3]. Because of the coupling between osteoclasts and osteoblasts, bone turnover would decrease.…”

mentioning

confidence: 99%

Diabetes and bone fracture: risk factors for old and young

Vestergaard

2014

Diabetologia

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Diabetes mellitus may affect bone turnover in a number of ways, thus leading to impaired bone quality and a consequent increase in fracture risk. These factors are summarised in this commentary.Keywords Bone mineral density . Diabetes mellitus . Fracture . Osteocalcin . Type 1 diabetes . Type 2 diabetes Abbreviation BMD Bone mineral density Diabetes and the skeleton have been linked on a number of levels, including an increased risk of fractures. Diabetes may affect both the young and the elderly. The mechanisms behind the increased fracture risk may be related to:1. Low-grade inflammation mainly linked to obesity affecting turnover in the skeleton [1]. This would predominantly be expected to be a factor in type 2 diabetes. It would by nature lead to a low turnover state in the bones, which is what is seen in diabetes [2, 3]. 2. An altered relationship between the beta cells and bone [4], as osteocalcin is involved in bone turnover but may also affect the beta cells [5]. If bone turnover is low, osteocalcin levels will decrease, and this may in theory further impair insulin secretion from the beta cells.3. Decreased bone turnover resulting from decreased osteoclastic resorption in bone with glycated collagen [2,3]. Because of the coupling between osteoclasts and osteoblasts, bone turnover would decrease. 4. Altered glycation of collagen and thus impaired biomechanical competence [6]. An increase in fractures stemming from this mechanism would not necessarily be reflected in changes in areal bone mineral density (BMD) determined by dual-energy X-ray absorptiometry (DXA) or other scanning techniques relying on measurements of calcium content of the bones. 5. Lack of the anabolic effects of insulin, which would be present in type 1 diabetes, and less so in type 2 diabetes, where insulin levels may be increased. However, altered levels of IGF1 may also play a role [7]. 6. Negative calcium balance brought about by hyperglycaemia through increased urinary calcium excretion [8] and altered intestinal calcium absorption [9]. 7. Alterations in vitamin D metabolism [10]-in particular in patients with renal disease. 8. Functional hypoparathyroidism [11]. This may be a less significant factor, as, in theory, hypoparathyroidism should lead to increased [12] and not decreased BMD. 9. Drug-specific effects, such as negative effects of peroxisome proliferator-activated receptor γ agonists [13], but also potential effects of other drugs, such as insulin or the oral glucose-lowering drugs.Besides these mechanisms, which are linked to bone biomechanical competence, increased risk of falls (for example, from peripheral neuropathy, impaired vision, hypoglycaemia, ischaemic cerebral events) may also play a role. These effects would not be linked to BMD.To further study these factors it is necessary to determine whether differences exist with age (say, older individuals being more susceptible than younger) or whether sex

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“…В ряде исследований зафик-сировано снижение концентрации в сыворотке крови маркеров костного образования: остеокальцина [6][7][8] и N-терминального пропептида коллагена I типа [8,9], а также маркера костной резорбции -C-терминальных телопептидов коллагена I типа (CTX) [7,9]. Данные о связи маркеров костного ремоделирования с показате-лями МПК и риском переломов у больных СД2 довольно фрагментарны и не позволяют составить целостную картину.…”

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The relationships between bone turnover markers and bone mineral density in postmenopausal type 2 diabetic women

et al. 2016

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Взаимосвязь маркеров ремоделирования костной ткани с минеральной плотностью костей у женщин с сахарным диабетом 2 типа, находящихся в постменопаузе © Климонтов В.В., Фазуллина О.Н., Лыков А.П., Коненков В.И. (all P < 0.0002), without any differences between groups. Osteoprotegerin levels were reduced in all patient groups but was significantly lower in diabetic women with osteoporosis and osteopenia compared to those with normal BMD (P = 0.003 and P = 0.01, respectively). Women with osteoporosis had higher urinary CTX-I excretion than control and diabetic women with normal BMD (P = 0.01 and P = 0.01, respectively). ФГБНУ Научно-исследовательский институт клинической и экспериментальной лимфологии, Новосибирск

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Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus

Abstract: Type 2 diabetic patients had suppressed bone turnover, which might explain the increased fracture risks, independent of BMD. IFG patients might also have poor bone quality and need early prevention.

Cited by 71 publications

References 28 publications

Epidemiology of fractures in type 2 diabetes

Epidemiology of fractures in type 2 diabetes

Diabetes and bone fracture: risk factors for old and young

The relationships between bone turnover markers and bone mineral density in postmenopausal type 2 diabetic women

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