Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes

Abstract

Objective The aim of this cross‐sectional study was to comprehensively assess bone health in women with prior gestational diabetes mellitus, including bone microarchitecture (TBS), bone mineral density (BMD, DXA) and bone turnover (osteocalcin). Design, Patients and Measurements Study participants underwent a detailed anthropometric, biochemical and hormone assessment, including insulin and osteocalcin measurement. BMD was measured at lumbar spine, femur neck and total hip using DXA and TBS derived from lumbar spine DXA images using TBS iNsight software. Results A total of 240 women (mean age: 33.3 ± 5.0 years; median postpartum duration: 34 [interquartile range 13.0–54.5] months were evaluated. At the current visit, 115 (47.9%) and 36 (15%) women had prediabetes and diabetes, respectively. Women with dysglycemia (diabetes/prediabetes) had a higher BMD at all three sites, compared to those with normoglycemia; however, the difference was not statistically significant. Women with dysglycemia had a significantly lower TBS (1.32 ± 0.09 vs. 1.35 ± 0.09; p = .038). In the fully adjusted model, the odds ratio for association between diabetes and low TBS was 2.92 (95% confidence interval: 1.20, 7.08; p = .018). Women with dysglycemia had significantly lower serum osteocalcin levels (18.6 ± 8.5 ng/ml vs. 21.5 ± 9.7 ng/ml; p = .018). HOMA‐IR (r = −.285, p < .001) was negatively correlated, while Matsuda index (r = .274, p < .001) and disposition index (r = .159, p = .016) were positively correlated with serum osteocalcin levels. Conclusions Bone health is affected early in the natural history of diabetes and is associated with an overall low bone turnover state.

Association of Bone Mineral Density and Bone Turnover Markers with the Risk of Diabetes: Hong Kong Osteoporosis Study and Mendelian Randomization

“…As osteocalcin declines over time, the glycemic status gradually changes from normoglycemia to diabetes. [ 35 ] We showed the inverse cross‐sectional relationship between osteocalcin and fasting glucose and Hb A1c in HKOS‐FU. However, the role of osteocalcin in humans remains controversial due to inconsistent findings.…”

Association of bone mineral density with prediabetes risk among African-American and European-American adult offspring of parents with type 2 diabetes

“…Another putative mechanism might involve osteocalcin. In a recent study of 240 women with prior gestational diabetes mellitus, participants with prediabetes or diabetes tended to have higher BMD and significantly lower serum osteocalcin levels compared with normoglycemic control ( 40 ). Osteocalcin levels declined serially as glycemic status shifted from normoglycemia to prediabetes to diabetes, and showed significant associations with BMD, plasma glucose, insulin sensitivity and insulin secretion in the study population ( 40 ).…”

Osteocalcina y su correlación con grasa corporal, glucosa durante la CTOG y función de la célula beta pancreática en pacientes con riesgo de diabetes

“…Los valores de OC tuvieron una correlación positiva significativa, aunque débil, con la función de la Cβ, y los niveles de OC fueron progresivamente menores en los grupos con menor función de la Cβ, similar a lo reportado en estudios previos en pacientes latinos y en mujeres con antecedente de diabetes gestacional y prediabetes [20][21][22] . Estudios previos han reportado también una correlación entre OC y sensibilidad a la insulina, aunque nosotros no encontramos dicha correlación 23 .…”