Type 2 Diabetes in Relation to Hip Bone Density, Area, and Bone Turnover in Swedish Men and Women: A Cross-Sectional Study

Mitchell, Adam; Fall, Tove; Melhus, Håkan; Wolk, Alicja; Michaëlsson, Karl; Byberg, Liisa

doi:10.1007/s00223-018-0446-9

Cited by 25 publications

(37 citation statements)

References 47 publications

(63 reference statements)

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“…In addition, levels of P1NP and OC were consistently lower throughout the day and night in patients with T2D compared to controls. Interestingly, we found that the plasma levels of the bone resorption marker CTX were similar in diabetes patients and controls throughout the 24 h. Our results are in line with previous studies that have shown low levels of bone formation markers in diabetes patients (7,20,21). Levels of P-BAP were similar in diabetes patients and controls, in line with previous studies (9) and the lack of postprandial changes is consistent with the long half-life of BAP (22).…”

Section: Discussionsupporting

confidence: 92%

The diurnal variation of bone formation is attenuated in adult patients with type 2 diabetes

Hygum

Starup-Linde

Harsløf

et al. 2019

European Journal of Endocrinology

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Objective Bone turnover has a diurnal variation influenced by food intake, incretin hormones, the sympathetic nervous system and osteocyte function. The aim of the study was to compare diurnal variation in bone turnover in patients with diabetes and controls. Design A clinical 24-h study with patients with type 1 diabetes (n = 5), patients with type 2 diabetes (n = 5) and controls (n = 5). Methods Inclusion criterion: age >50 years. Exclusion criteria: diseases/medication that affect bone metabolism or recent use of incretin-based drugs. We drew blood samples hourly during the day and every 3 h during the night. We served an identical diet on all study days. We used repeated-measures one-way ANOVA to compare the levels of the investigated markers, and we quantified the effect of time by comparing group mean standard deviations. Results The bone formation marker procollagen type 1 N-terminal propeptide showed a significant interaction between time and group (P = 0.01), and the mean standard deviation was lower in patients with type 2 diabetes compared with controls (P = 0.04) and patients with type 1 diabetes (P = 0.02). Other markers of bone formation and resorption showed significant effect of time. Levels of glucagon-like peptide-2, glucose-dependent insulinotropic peptide and sclerostin only showed significant effect of time (all P values 0.01), but levels of sclerostin tended to being highest in type 2 diabetes and lowest in controls. Conclusions The diurnal variation in bone formation is attenuated in patients with type 2 diabetes. This is not explained by changes in incretin hormone levels, but possibly mediated by sclerostin.

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Section: Discussionsupporting

confidence: 92%

The diurnal variation of bone formation is attenuated in adult patients with type 2 diabetes

Hygum

Starup-Linde

Harsløf

et al. 2019

European Journal of Endocrinology

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“…These findings suggest a relative hypermineralization in patients with T2D which could explain the higher BMD [ 26 ]. Low levels of bone turnover markers in T2D has also been reported in other meta-analysis [ 27 28 ]. Bone turnover markers are lower in patients with T2D compared with patients with T1D [ 29 ]; thus, the low bone turnover-state may be specific to T2D.…”

Section: Low Bone Turnover In Diabetic Bone Diseasesupporting

confidence: 68%

Skeletal Fragility in Type 2 Diabetes Mellitus

2018

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Type 2 diabetes (T2D) is associated with an increased risk of fracture, which has been reported in several epidemiological studies. However, bone mineral density in T2D is increased and underestimates the fracture risk. Common risk factors for fracture do not fully explain the increased fracture risk observed in patients with T2D. We propose that the pathogenesis of increased fracture risk in T2D is due to low bone turnover caused by osteocyte dysfunction resulting in bone microcracks and fractures. Increased levels of sclerostin may mediate the low bone turnover and may be a novel marker of increased fracture risk, although further research is needed. An impaired incretin response in T2D may also affect bone turnover. Accumulation of advanced glycosylation endproducts may also impair bone strength. Concerning antidiabetic medication, the glitazones are detrimental to bone health and associated with increased fracture risk, and the sulphonylureas may increase fracture risk by causing hypoglycemia. So far, the results on the effect of other antidiabetics are ambiguous. No specific guideline for the management of bone disease in T2D is available and current evidence on the effects of antiosteoporotic medication in T2D is sparse. The aim of this review is to collate current evidence of the pathogenesis, detection and treatment of diabetic bone disease.

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“…The pattern observed appears to be similar to that reported for diabetes; BMD in IFG is either higher or not different from normoglycaemia. A study by Mitchell et al [20], which included 150 participants with IFG defined according to ADA criteria, the same as in our study, showed that total hip and femoral shaft BMD was higher in men and not different in women with IFG compared with normoglycaemia. As part of a study investigating fracture risk in elderly men, Napoli et al [21] reported a higher unadjusted total hip BMD for men with Italics indicate where statistically significant differences were observed between the three glycaemia groups IFG (ADA criteria) compared with normoglycaemia.…”

Section: Discussionsupporting

confidence: 75%

Bone mineral density in diabetes and impaired fasting glucose

et al. 2019

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We report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher lumbar spine bone mineral density (LSBMD). Femoral neck bone mineral density (FNBMD) was higher in obese postmenopausal women with diabetes. Only non-obese post-menopausal women with impaired fasting glucose (IFG) had a higher LSBMD than normoglycaemia. No other associations with IFG were observed. Introduction Individuals with diabetes have a higher or normal bone mineral density (BMD) compared with those without diabetes. However, paradoxically, they also have a higher fracture risk. It is not clear whether those with IFG also have altered BMD. This study aimed to determine whether individuals with IFG have elevated or normal BMD. Methods Women (n = 858) and men (n = 970) (aged 20-80 years) from the Geelong Osteoporosis Study were included. IFG was defined as fasting plasma glucose (FPG) 5.5-6.9 mmol/L and diabetes as FPG ≥ 7.0 mmol/L, use of antihyperglycaemic medication and/or self-report. Using multivariable linear regression, the relationships between glycaemia and BMD at the femoral neck and lumbar spine were examined, and adjusted for age, body mass index (BMI), and other variables. In women, two interaction terms were identified: menopause × glycaemia and BMI × glycaemia, and thus, the analyses were stratified by menopause and obesity status (BMI cut point ≥ 30 kg/m 2). Results There were no associations between glycaemic status and BMD for pre-menopausal women. For non-obese postmenopausal women, there was no association between FNBMD and glycaemic status, but women with IFG or diabetes had higher LSBMD than those with normoglycaemia (7.1% and 9.7%, respectively, both p < 0.01). Obese post-menopausal women with diabetes had a higher FNBMD (8.8%, p = 0.008) and LSBMD (12.2%, p < 0.001), but those with IFG were not different from the normoglycaemia group. There were no associations detected between glycaemic status and BMD in men. Conclusions In this study, we report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher LSBMD. FNBMD was higher in obese post-menopausal women with diabetes. Only non-obese postmenopausal women with IFG had a higher LSBMD than normoglycaemia. No other associations with IFG were observed.

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Type 2 Diabetes in Relation to Hip Bone Density, Area, and Bone Turnover in Swedish Men and Women: A Cross-Sectional Study

Cited by 25 publications

References 47 publications

The diurnal variation of bone formation is attenuated in adult patients with type 2 diabetes

The diurnal variation of bone formation is attenuated in adult patients with type 2 diabetes

Skeletal Fragility in Type 2 Diabetes Mellitus

Bone mineral density in diabetes and impaired fasting glucose

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