Mineral Metabolism and Bone Mass at Peripheral and Axial Skeleton in Diabetes Mellitus

Abstract

Bone mineral content (BMC), mineral homeostasis, and diabetes control were evaluated in 31 Caucasian insulin-dependent diabetic patients (disease duration 18.3 +/- 7.7 yr, mean +/- SD) with normal kidney function. To evaluate bone mass, we performed radiogrammetry and single- and dual-photon absorptiometry. In women, a significantly lower mean BMC was found in the distal radius, at a mixed trabecular-cortical (P less than .01) and a cortical (P less than .05) site, as well as in the lumbar spine (P less than .02). In diabetic men, mean BMC was significantly reduced at the trabecularcortical (P less than .01) and cortical (P less than .05) sites of the radius but not in the lumbar spine. When expressed as densities (i.e., BMC/width or lumbar BMC/area), only the BMC/width at the radius cortical area was significantly reduced in women (P less than .05). The results of the radiogrammetry showed a larger endosteal diameter in the diabetic women, resulting in a significantly lower cortical thickness (P less than .05). Diabetic men did not show abnormalities on radiogrammetry. Diabetic patients had diminished serum calcium and phosphorus concentrations (P less than .001), whereas serum parathyroid, 25-hydroxyvitamin D3, and concentrations of both total and free 1,25-dihydroxyvitamin D3 were normal. No correlation between parameters of diabetes control (HbA1, insulin dose, and triglycerides) or calcium-regulating hormones and BMC were found. These data confirm that, despite large overlap of individual values, mean bone mass at the peripheral skeleton is significantly decreased in diabetic patients. Moreover, we report that the BMC of the lumbar spine is significantly reduced in female diabetic patients.

Type 1 diabetes and osteoporosis: A review of literature

“…[9] Many studies, though not all, carried out with the older techniques to measure BMD, like single photon absorptiometry (SPA) or dual photon absorptiometry (DPA), demonstrated that BMD is lower in adolescents and adults with T1DM compared to control population. [1011121314] Similar findings have been noted by the recent studies carried out using newer technologies to measure BMD like dual X-ray absorptiometry (DXA). [15161718] However, the data is not consistent among all the studies.…”

Role of hemoglobin A1c, duration and puberty on bone mineral density in diabetic children

“…We were not able to demonstrate a correlation between the insulin dose and the BMD‐Z score. Several other studies also reported no correlation between the insulin dosage and BMD and bone formation parameters 16,21,26,29,31 …”

“…Although it is shown that insulin therapy does reverse the negative effects of diabetes on bone mineralization, 15,16,18 a direct relationship between insulin dose and BMD, BMC and/or bone formation parameters could not be shown in most of the studies 16,21,26,29,31 …”

Bone and glucose metabolism: A two-way street

“…However, it cannot be used in conjunction with total OC assays to determine %ucOC because of differences in standardization and sensitivity to circulating fragments (3). Takara also offers a combination kit that will measure fully carboxylated osteocalcin (gla-type) in parallel with uncarboxylated osteocalcin (glu-type).…”