Low Bone Turnover Associates With Lower Insulin Sensitivity in Newly Diagnosed Drug-Naïve Persons With Type 2 Diabetes

Abstract

Context Bone turnover markers (BTMs) are lower in type 2 diabetes (T2D). The relationships between bone turnover, β-cell function, and insulin sensitivity in T2D are uncertain. Objective To investigate if fasting levels of BTMs in persons with T2D are associated with β-cell function or insulin sensitivity. Methods We defined three T2D phenotypes: the insulinopenic (low β-cell function, high insulin sensitivity), the classical (low β-cell function, low insulin sensitivity) and the hyperinsulinemic (high β-cell function, low insulin sensitivity) phenotypes, in the Danish Centre for Strategic Research in T2D cohort, using the homeostatic assessment model. We selected age and gender matched subgroups to represent the three T2D phenotypes, yielding 326 glucose-lowering treatment naïve persons with T2D. Median values of BTMs between the three T2D phenotypes were compared. Regression models were applied to assess the association between BTMs, β-cell function and insulin sensitivity, adjusted for potential confounders. Results Median serum levels of procollagen type I N-terminal propeptide, C-terminal telopeptide of type I collagen and osteocalcin were higher in the insulinopenic phenotype (52.3 (μg/L) IQR [41.6, 63.3], 259.4 (ng/L) [163.4, 347.7], 18.0 (μg/L) [14.4, 25.2], respectively) compared to the classical (41.4 [31.0, 51.4], 150.4 [103.5, 265.1], 13.1 [10.0, 17.6], respectively) and the hyperinsulinemic (43.7 [32.3, 57.3], 163.3 [98.9, 273.1], 15.7 [10.2, 20.8], respectively) phenotypes (all p < 0.01). These differences persisted after adjustment for age, sex, waist-to-hip ratio, or fasting plasma glucose (p < 0.01). Conclusion BTMs are lower in newly diagnosed persons with T2D characterized by low insulin sensitivity.

Osteocalcin associates with bone mineral density and VDR gene polymorphisms in type 1 and type 2 diabetes

“…It appears that diabetic patients show a dissociative pattern, as changes in formation are not mirrored by similar changes in resorption [ 7 ]. It is possible to find low BTM levels with low, normal or even elevated BMD in patient at increased risk of fracture suggesting that traditional reference ranges may not be adequate for clinical decisions [ 8 ]. So more studies are needed to establish the usefulness of BTM as a screening tool in diabetic population.…”

La osteocalcina se asocia con la densidad mineral ósea y los polimorfismos del gen VDR en la diabetes tipo 1 y 2

“…Parece que los pacientes diabéticos muestran un patrón disociativo, puesto que los cambios en la formación ósea no se ven reflejados en cambios en la resorción [ 7 ]. Es posible encontrar niveles bajos de MRO con una DMO baja, normal o incluso elevada en pacientes con mayor riesgo de fractura, lo que sugiere que los intervalos de referencia tradicionales pueden no ser adecuados para la toma de decisiones clínicas [ 8 ]. Por lo tanto, se necesitan más estudios para establecer la utilidad de los MRO como herramienta de cribado en la población diabética.…”