Lack of relationship between glycemic control and bone mineral density in type 2 diabetes mellitus

Abstract

We assessed the effect of chronic hyperglycemia on bone mineral density (BMD) and bone remodeling in patients with type 2 diabetes mellitus. We investigated 42 patients with type 2 diabetes under stable control for at least 1 year, 22 of them with good metabolic control (GMC: mean age = 48.8 ± 1.5 years, 11 females) and 20 with poor metabolic control (PMC: mean age = 50.2 ± 1.2 years, 8 females), and 24 normal control individuals (CG: mean age = 46.5 ± 1.1 years, 14 females). We determined BMD in the femoral neck and at the L2-L4 level (DEXA) and serum levels of glucose, total glycated hemoglobin (HbA 1 ), total and ionic calcium, phosphorus, alkaline phosphatase, follicle-stimulating hormone, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OH-D), insulin-like growth factor I (IGFI), osteocalcin, procollagen type I C propeptide, as well as urinary levels of deoxypyridinoline and creatinine. HbA 1 levels were significantly higher in PMC patients (12.5 ± 0.6 vs 7.45 ± 0.2% for GMC and 6.3 ± 0.9% for CG; P < 0.05). There was no difference in 25-OH-D, iPTH or IGFI levels between the three groups. BMD values at L2-L4 (CG = 1.068 ± 0.02 vs GMC = 1.170 ± 0.03 vs PMC = 1.084 ± 0.02 g/cm 2 ) and in the femoral neck (CG = 0.898 ± 0.03 vs GMC = 0.929 ± 0.03 vs PMC = 0.914 ± 0.03 g/cm 2 ) were similar for all groups. PMC presented significantly lower osteocalcin levels than the other two groups, whereas no significant difference in urinary deoxypyridine was observed between groups. The present results demonstrate that hyperglycemia is not associated with increased bone resorption in type 2 diabetes mellitus and that BMD is not altered in type 2 diabetes mellitus.

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

“…Neither s-calcium nor u-calcium differed between T2D and controls (Gregorio et al, 1994; Hampson et al, 1998; Achemlal et al, 2005; Oz et al, 2006; Cutrim et al, 2007; Zhou et al, 2010; Garcia-Martin et al, 2012b; Shu et al, 2012). S-calcium appears not to correlate to HbA1c or BMD (Levy et al, 1986; Hampson et al, 1998), thus making it a poor marker of bone- and glycemic-status in T2D.…”

“…S-calcium appears not to correlate to HbA1c or BMD (Levy et al, 1986; Hampson et al, 1998), thus making it a poor marker of bone- and glycemic-status in T2D. The PTH-vitamin D axis; S-PTH, 1,25OHD, s-25OHD, and calcitonin are most likely not to be affected in T2D (Pedrazzoni et al, 1989; Gregorio et al, 1994; Hampson et al, 1998; Achemlal et al, 2005; Dobnig et al, 2006; Oz et al, 2006; Cutrim et al, 2007; Zhou et al, 2010; Garcia-Martin et al, 2012b; Gennari et al, 2012; Shu et al, 2012; Reyes-Garcia et al, 2013). The positive relationship between s-PTH and the resorptive markers s-TRAP-5b and s-CTX (Reyes-Garcia et al, 2013) suggests that PTH induce bone resorption in T2D.…”

“…The increase in BMD is inconsistent with the antagonizing effect on the Wnt-pathway (Manolagas and Almeida, 2007). When looking at bone turnover markers of collagen; u-NTX is higher (Zhou et al, 2010) and s-NTX, s-PICP, s-CICP, and u-DPD seem not to differ (Hampson et al, 1998; Oz et al, 2006; Cutrim et al, 2007; Shu et al, 2012), while u-crosslaps, s-CTX, and s-P1NP are lower (Christensen and Svendsen, 1999; Dobnig et al, 2006; Oz et al, 2006; Garcia-Martin et al, 2012b; Gennari et al, 2012; Shu et al, 2012; Reyes-Garcia et al, 2013), suggesting that bone turnover is changed in T2D. The differences in bone resorption markers may reflect different points of progress in T2D bone affection or the fact that markers may be sensitive or insensitive in T2D.…”

Obesity, diabetes mellitus and last but not least, osteoporosis

“…Low body weight, hypoinsulinemia and low serum levels of IGF-I are common clinical and biochemical features of T1DM, which are not encompassed within T2DM (30). Poor glucose control is an etiological factor for the microangiopathic complications that develop in all DM types.…”

Correlation serum level of 25(OH)D and bone density in type 2 diabetes mellitus patients

“…25(OH)D serum is inactive vitamin D serum, collected at 09.00 to 12.00 pm and examination of serum levels of vitamin D were based on the examination technique CLIA (chemiluminescent immunoassay), with a normal interpretation ≥30ng/ml, insufficiency if the level range from 10 to 30 ng/ml, deficiency if the range <10 ng/ml [15,16].…”