Bone Mineral Density in Relation to Metabolic Syndrome Components in Postmenopausal Women With Diabetes Mellitus Type 2

Abstract

SUMMARY -Diabetes mellitus type 2 is associated with greater bone mineral density (BMD) due to obesity, although rapid bone loss observed over time could be explained by elevated chronic infl ammation. Th e objective of this study was to investigate the relationship between central adiposity and hyperinsulinemia, as well as infl ammation markers with vertebral and femoral BMD and bone turnover markers in postmenopausal women with type 2 diabetes. Femoral and vertebral BMD, osteocalcin, pyrilinks D, beta-CrossLaps (B-CTx), insulin, C-reactive protein (CRP), fi brinogen and plasminogen activator inhibitor-1 (PAI-1) were measured in 114 postmenopausal female patients with diabetes type 2. Th e patients of similar age, HbA1c levels and diabetes duration were divided into 2 groups based on their body mass index (BMI) values: lower or equal to 27 kg/m 2 (31 patients) and higher than 27 kg/m 2 (83 patients). Lower levels of osteocalcin (p=0.001), B-CTx (p=0.000007) and pyrilinks D (p=0.0365), and higher femoral BMD (p=0.00006), insulin level (p=0.0002), PAI-1 (p=0.00000) and CRP (p=0.002) were found in the overweight group. Th ere were no signifi cant diff erences in vertebral BMD and fi brinogen. Osteocalcin and B-CTx showed inverse correlation, and femoral BMD positive correlation with waist circumference, insulin level and PAI-1. Th is suggests that abdominal obesity and hyperinsulinemia as components of the metabolic syndrome could increase femoral BMD by lowering bone rate. In addition, the only infl ammation marker linked with femoral BMD was PAI-1, which is associated with increased mineralization of cortical bone in mouse models.

Diabetes and Bone Fragility

“…However, there is uncertainty about how mechanisms induced by obesity may have a negative effect on bone [46]. A cross-sectional study assessed central obesity, hyperinsulinemia, inflammatory markers, and bone health (BMD and bone turnover markers) among 114 postmenopausal women with T2D [47]. Femoral BMD was positively associated with BMI, waist circumference, plasma insulin, and PAI-1 (plasminogen activator inhibitor 1).…”

Bone Markers in Arthropathies

“…Among other BMs, lower levels of OC and CTX were found in overweight postmenopausal women with diabetes type 2 84 , and higher MGP levels in postmenopausal women with calcified minor carotid stenosis, regardless of the presence of osteopenia and osteoporosis 85 .…”

Including selective metabolic components in current diagnostic criteria does not improve discriminative validity for metabolic syndrome: a risk score approach

“…Among them, BMI, SBP, DBP, TG, HDL-C and FG were selected according to MetS definition. 1,23 The others were included based on previous studies such as BMD, 24 WBC, 25 Hb, 26 HCT, 27 UA, 8,9 LDL-C 4 and GPT. 6,7 As each subject had at least three health examinations, this study used the marker data from the first examination for this analysis.…”