Bone Metabolism and Fracture Risk in Diabetes Mellitus

Puspitasari, Melisa; Purnamasari, Dyah; Setyohadi, Bambang; Isbagio, Harry

doi:10.15605/jafes.032.02.14

Cited by 6 publications

(4 citation statements)

References 119 publications

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“…AGEs crosslinking in collagen also leads to more brittle bones that are less able to deform before fracturing [ 51 ]. CTX is the degradation product of type I collagen [ 29 ] and is used in numerous studies in T2DM as a marker of bone resorption [ 52 ]. and there is the possibility that the degraded type I collagen might have already been glycated in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Low bone turnover in premenopausal women with type 2 diabetes mellitus as an early process of diabetes-associated bone alterations: a cross-sectional study

et al. 2017

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BackgroundIndividuals with Diabetes Mellitus (DM) are at increased risk for fracture due to the decrease in bone strength and quality. Serum procollagen type I intact N-terminal (P1NP) and serum C-terminal cross-linking telopeptide of type I collagen (CTX) as markers of bone formation and resorption, respectively, have been reported to be decreased in T2DM. It remains unclear whether diabetes-associated alterations in the bone turnover of T2DM individuals are related to the longer duration of the disease or may occur earlier. Furthermore, previous studies on BTMs in T2DM individuals have mostly been done in postmenopausal women with T2DM, which might have masked the DM-induced alterations of bone turnover with concurrent estrogen deficiency. This study aims to assess the levels of serum P1NP and CTX as markers of bone turnover in premenopausal women with and without T2DM.MethodsThis cross-sectional study involves 41 premenopausal women with T2DM, and 40 premenopausal women without DM. Sampling was done consecutively. P1NP and CTX measurement was done using the electrochemi-luminescence immunoassay (ECLIA) method. Other data collected include levels of HbA1C, ALT, creatinine, eGFR and lipid profile.ResultsMedian (interquartile range) P1NP in T2DM is 29.9 ng/ml (24.7–41.8 ng/ml), while in non-DM is 37.3 ng/ml, (30.8–47.3 ng/ml; p = 0.007). Median (interquartile range) CTX in T2DM is 0.161 ng/ml (0.106–0.227 ng/ml), while in non-DM is 0.202 ng/ml (0.166–0.271 ng/ml; p = 0.0035). Levels of P1NP and CTX in the T2DM group did not correlate with the duration of disease, age, BMI or the levels of HbA1C.ConclusionsPremenopausal women with T2DM indeed have lower bone turnover when compared with non-DM controls. This significantly lower bone turnover process starts relatively early in the premenopausal age, independent of the duration of DM. Gaining understanding of the early pathophysiology of altered bone turnover may be key in developing preventive strategies for diabetoporosis.

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Section: Discussionmentioning

confidence: 99%

Low bone turnover in premenopausal women with type 2 diabetes mellitus as an early process of diabetes-associated bone alterations: a cross-sectional study

et al. 2017

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“…Diabetes mellitus (DM) is a chronic metabolic disease with an alarming increasing global prevalence (Puspitasari et al, 2017). The prevalence of DM among adults was estimated at 10.…”

Section: Introductionmentioning

confidence: 99%

“…Diabetes mellitus (DM) is a chronic metabolic disease with an alarming increasing global prevalence (Puspitasari et al, 2017). The prevalence of DM among adults was estimated at 10.5% (536.6 million) in 2021 and is projected to reach 12.2% (783.2 million) in 2045 (Sun et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Calcium phytate reverses high glucose‐inhibited osteogenesis of BMSCs via the MAPK/JNK pathway

Wang

Liu

et al. 2023

Oral Diseases

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ObjectivesDiabetes mellitus (DM) induces oxidative tissue impairment and suppresses bone formation. Some studies have shown that phytic acid has antioxidant and anti‐diabetic properties. This study aimed to investigate the potential of calcium phytate (Ca‐phytate) to reverse inhibited osteogenesis of human bone marrow mesenchymal stem cells (hBMSCs) in a high glucose (HG) environment and to determine the underlying mechanism.Materials and MethodshBMSCs were exposed to HG and palmitic acid to simulate DM in vitro. Osteogenic differentiation was measured using alkaline phosphatase staining and activity assay, alizarin red S staining, qRT‐PCR, Western blot and immunofluorescence staining. A critical‐size cranial defect model of type 2 diabetes mellitus (T2DM) rats was established to evaluate bone regeneration. A specific pathway inhibitor was used to explore whether the MAPK/JNK pathway was involved.ResultsTreatment with 34 μM Ca‐phytate had the highest effect on osteogenic differentiation in HG. Ca‐phytate improved cranial bone defect healing in T2DM rats. The long‐term HG environment inhibited the activation of the MAPK/JNK signalling pathway, which was restored by Ca‐phytate. Blocking the JNK pathway reduced the Ca‐phytate‐mediated osteogenic differentiation of hBMSCs.ConclusionCa‐phytate induced bone regeneration in vivo and reversed HG‐inhibited osteogenesis of hBMSCs in vitro via the MAPK/JNK signalling pathway.

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“…3 DM is known to be associated with increased risk of adverse outcomes during the postoperative period within the surgical sphere. [4][5][6][7] Specifically for elective spine surgery, DM has been associated with changes in bone metabolism, thus leading to increased fracture risks, 8 as well as elevated risk of surgical site infection (SSI). 9,10 DM has been demonstrated to be associated with delayed wound healing, increased rate of infection, cardiac complications, intensive care unit admissions, prolonged hospital stay, and higher postoperative mortality.…”

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confidence: 99%

Does Tighter Glycemic Control Beyond Hemoglobin A1c of 8% Improve Outcome for Lumbar Spine Surgery? A MSSIC Study

Telemi,

Mansour,

Brennan

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Diabetes mellitus is associated with increased risk of postoperative adverse outcomes. Previous studies have emphasized the role of glycemic control in postoperative complications. This study aims to ascertain whether controlling hemoglobin A1c (HbA1c) lower than 8% preoperatively results in meaningful risk reduction or improved outcomes. METHODS: We used patient-level data from the Michigan Spine Surgery Improvement Collaborative registry, focusing on patients who underwent elective lumbar spine surgery between 2018 and 2021. The primary outcomes were length of stay and the occurrence of postoperative adverse events. Secondary outcomes included patient satisfaction, achievement of a minimum clinically important difference (MCID) of Patient-Reported Outcomes Measurement Information System-Physical Function, the EuroQol-5D and NRS of leg and back pain, and return to work. RESULTS: A total of 11 348 patients were included in this analysis. Patients with HbA1c above the thresholds before surgery had significantly higher risks of urinary retention for all 3 possible threshold values (incidence rate ratio [IRR] = 1.30, P = .015; IRR = 1.35, P = .001; IRR = 1.25, P = .011 for the HbA1c cutoffs of 8%, 7.5%, and 7%, respectively). They also had longer hospital stay (IRR = 1.04, P = .002; IRR = 1.03, P = .001; IRR = 1.03, P < .001 for the HbA1c cutoffs of 8%, 7.5%, and 7%, respectively) and had higher risks of developing any complication with HbA1c cutoff of 7.5% (IRR = 1.09, P = .010) and 7% (IRR = 1.12, P = .001). Diabetics with preoperative HbA1c above all 3 thresholds were less likely to achieve Patient-Reported Outcomes Measurement Information System MCID at the 90-day follow-up (IRR = .81, P < .001; IRR = .86, P < .001; IRR = .90, P = .007 for the HbA1c cutoffs of 8%, 7.5%, and 7%, respectively) and less likely to achieve EuroQol-5D MCID at the 2-year follow-up (IRR = .87, P = .027; IRR = .84, P = .005 for the HbA1c cutoffs of 7.5% and 7%, respectively). CONCLUSION: Our study suggests that reducing HbA1c below 8% may have diminishing returns regarding reducing complications after spine surgery.

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Bone Metabolism and Fracture Risk in Diabetes Mellitus

Cited by 6 publications

References 119 publications

Low bone turnover in premenopausal women with type 2 diabetes mellitus as an early process of diabetes-associated bone alterations: a cross-sectional study

Low bone turnover in premenopausal women with type 2 diabetes mellitus as an early process of diabetes-associated bone alterations: a cross-sectional study

Calcium phytate reverses high glucose‐inhibited osteogenesis of BMSCs via the MAPK/JNK pathway

Does Tighter Glycemic Control Beyond Hemoglobin A1c of 8% Improve Outcome for Lumbar Spine Surgery? A MSSIC Study

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