Context Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fractures. No study has evaluated the correlation of bone histomorphometry (BH) parameters with glycemic control and presence of chronic complications (CCs) in premenopausal women with T2DM. Objectives To evaluate BH and correlate them with the degree of glycemic control and presence of CCs. Design, settings, and patients This was a cross-sectional study conducted at a tertiary medical center. Twenty-six premenopausal women with T2DM were divided into groups with glycated hemoglobin HbA1c < 7% (good control, GC; n = 10) and HbA1c > 7% (poor control, PC; n = 16), and further subdivided into groups with (n = 9) and without (n = 17) CCs. BH parameters (bone volume [bone volume per total volume, BV/TV], trabecular thickness [Tb.Th], trabecular number [Tb.N], trabecular separation [Tb.Sp], osteoid thickness [O.Th], osteoid surface [osteoid surface per bone surface, OS/BS]), mineralizing surface [MS/BS], bone formation rate [BFR]), mineral apposition rate [MAR]) as well as serum pentosidine (PEN) and insulin-like growth factor (IGF)-1 were measured. The BH data were compared among the groups and with a BH control group (control group, CG, n = 15) matched by age, sex, and race. Results BV/TV was increased in GC (P < .001) and PC (P = .05) groups and O.th (P = .03) was smaller in the PC group than in the CG. A comparison of the groups with and without CCs with the CG showed in the group with CCs, O.Th was smaller(P = .01) and BV/TV similar to the CG (P = .11). HbA1c correlated negatively with O.Th (P = .02) and OS/BS (P = .01). There was no correlation of BH to PEN and IGF-1. Conclusion BH in premenopausal patients with T2DM is affected by disease control and chronic complications.

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Context No study has evaluated the relationships among of bone marrow adiposity(BMA), bone histomorphometry(BH) and glycemic control in premenopausal women with type 2 diabetes(T2DM). Objectives Assess the effect of glycemic control on BMA;correlate the parameters of BH with BMA and correlate BMA with the use of hypoglycemic agents and with BMD. Design, settings and patients This was a cross-sectional study that evaluated 26 premenopausal women with T2DM were divided into groups with HbA1c<7% (GC,n=10) and HbA1c>7% (PC,n=16).BMA parameters (Ad.N, Ad.Pm, Ad.Ar, Ad.V/Ma.V and peri-trabecular adipocyte number (Ad.N/BS) were evaluated.BH static(BV/TV, O.Th, OS/BS) and dynamic parameters and serum IGF-1 were measured.BMA data were compared between the GC vs PC groups. Correlations were performed. Results Ad.N, Ad.Pm and Ad.Ar were higher in PC(all, p=0.04). HbA1c correlated positively with Ad.N/BS(p< 0.01) and Ad.N/BS correlated negatively with O.Th(p<0.01) and OS/BS(p=0.02). Positive and negative correlations were observed between insulin and metformin use, respectively, with all adipocyte parameters except Ad.N/BS(p<0.05). Structural parameters were negatively correlated with the BMA. BMD of the femoral neck(r = -549, p<0.01) and total femur(r=-0.502, p<0.01) were negatively correlated with Ad.V/Ma.V. Conclusion Poor glycemic control is associated with hyperplasia and hypertrophy of BMAs and with lower BVTV. Ad,N/BS, a new BMA parameter, is correlated with HbA1c and negatively with O.Th. The use of insulin seems to stimulate the expansion of BMA while that of metformin has the opposite effect. These findings suggest that the increase in BMA may play a role in the T2DM bone disease, on the other hand, good glycemic control might help prevent it.

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