Bone Turnover Markers in Patients with Type 2 Diabetes and Their Correlation with Glycosylated Haemoglobin Levels

Abstract

The aim of this prospective, longitudinal study was to investigate, over a period of 12 months, the effects of metabolic control on bone turnover markers in patients with type 2 diabetes mellitus. The study included 17 male and 18 female patients with type 2 diabetes, aged 37 -66 years. Mean follow-up period was 12 ± 1.2 months. Mean glycosylated haemoglobin (HbA 1C ) levels were 10.6% ± 1.6% at the start of the study and decreased to 7.7% ± 1.0% by the end of the study. Levels of the bone resorption markers, urinary deoxypyridinoline and N-telopeptide, were 28.6 ± 11.6 nmol/mmol creatinine and 93.6 ± 13.7 nmol bone collagen equivalents [BCE]/mmol creatinine, respectively, at the start of the study, and decreased significantly to 17.9 ± 7.1 nmol/mmol creatinine and 67.8 ± 12.8 nmol BCE/mmol creatinine, respectively, by the end of the study. Bone formation parameters also significantly decreased in parallel with HbA 1c levels over the study period. It is concluded that effective management of metabolic disorder in patients with type 2 diabetes plays an important contribution to bone turnover improvement.

Distinct effects of pioglitazone and metformin on circulating sclerostin and biochemical markers of bone turnover in men with type 2 diabetes mellitus

“…Treatment with MET for 24 weeks had no apparent effect on serum sclerostin levels, but significantly decreased bone turnover, as assessed by serum markers of bone formation (P1NP) and bone resorption (CTX). A decrease in bone turnover has been previously reported after MET treatment (30,31), but a similar decrease in bone turnover has also been observed after improvement of glycemic control using other therapeutic regimens, such as diet or insulin administration (32). However, the different effects on bone turnover observed in our study in the PIO-treated patients despite a similar control of glucose metabolism demonstrate that the two agents have different effects on bone metabolism that are independent of their glucose-lowering action.…”

Diabetes, Biochemical Markers of Bone Turnover, Diabetes Control, and Bone

“…The glycemic control seems not to change s-BAP, ucOC, s-PTH, s-25OHD, and s-adiponectin, while u-PYR and s-IGF-1 seem to increase, and u-DPD, u-HP, u-calcium, and u-NTX seem to decrease (Gregorio et al, 1994; Rosato et al, 1998; Capoglu et al, 2008; Kanazawa et al, 2009b). S-OC may not change, increase, or decrease during glycemic control (Gregorio et al, 1994; Capoglu et al, 2008; Kanazawa et al, 2009b, 2011a), where a short period of glycemic control increase s-OC, intermediate periods decrease s-OC, and the longest available period of glycemic control (2 years) increase s-OC (Rosato et al, 1998). The previously proposed positive effect of glycemic control on OC may be present, however the link between OC and glycemic control seems ambiguous due to the different reports.…”

“…Over time, u-NTX does not seem to change in T1D. During glycemic control through 12 months T2D may decrease in u-NTX (Capoglu et al, 2008), while shorter periods do not seem to affect u-NTX.…”

Diabetes pharmacotherapy and effects on the musculoskeletal system

“…The effects of metformin on systemic bone biomarker concentrations have also been investigated as an indirect assessment of its drug‐related skeletal impact. Several studies in adults with T2D, along with one study in adults with non‐alcoholic fatty liver disease, suggest that extended treatment with metformin results in a decrease in biomarkers of bone turnover including Procollagen type 1 amino‐terminal propeptide (P1NP) and carboxy‐terminal collagen crosslinks (CTX), related, in some studies, to the improvement in glycemic control . These changes are not necessarily confirmed, however, following shorter duration of metformin exposure …”