The Relationship Between Prediabetes and Bone Mass in Adolescents: Analysis of the National Health and Nutrition Examination Survey From 2005 to 2010

Abstract

ObjectiveThe purpose of this study was to observe the relationship between impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and bone mineral density (BMD) in different sites in adolescents.MethodsA retrospective study was conducted on adolescents age 12–19 years of the United States. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, and 2009–2010 cycles. IFG was defined as fasting plasma glucose (FPG) levels that were ≥5.6 and <7.0 mmol/L. IGT was defined as 2-h plasma glucose levels that were ≥7.8 and <11.1 mmol/L after the oral glucose tolerance test (OGTT).ResultsAfter controlling for age, gender, race, and body mass index (BMI) Z-score, adolescents in different categories of IGT had significantly different levels of areal BMD (aBMD) and bone mineral apparent density (BMAD) (IGT main effect: P < 0.05 for all, two-way ANOVA). There was no main effect between different categories of IFG with regard to aBMD and BMAD (P > 0.05). There was no interaction between IFG and IGT with regard to aBMD and BMAD (P > 0.05). In multiple regression analysis, the 2-h plasma glucose maintained an independent association with femoral neck aBMD (β = −0.011, 95% CI: −0.017~−0.006, P < 0.001, R2 = 0.012), total femur aBMD (β = −0.015, 95% CI: −0.021~−0.009, P < 0.001, R2 = 0.018), total spine aBMD (β = −0.015, 95% CI: −0.020~−0.010, P < 0.001, R2 = 0.018), and total spine BMAD (β = −0.002, 95% CI: −0.003~0.000, P = 0.006, R2 = 0.003).ConclusionThe present study demonstrates that BMD was decreased in adolescents with IGT. Two-hour plasma glucose, not FPG, negatively correlated with BMD. The effect of 2-h plasma glucose was consistent across the sites of bone.

Insulin resistance and skeletal health

“…Most recent clinical studies evaluating relationships between insulin resistance and bone health have used dual-energy X-ray absorptiometry (DXA) to assess BMD and bone mineral content (BMC) [17 ▪ ,45–51]. Bone outcomes from DXA have strong clinical application, but DXA is limited by its inability to distinguish between cortical and trabecular bone compartments because of its two-dimensional nature.…”

“…Despite people with T2D having otherwise ‘normal’ bone mineral density (BMD) [12,13], diabetes is associated with increased risk for fracture [14] and impaired fracture healing [15,16]. Even in the absence of T2D, biological factors involved in diabetes pathogenesis have been implicated in bone health deficits [17 ▪ ]. Insulin resistance is a main feature of subclinical glucose dysregulation leading to T2D and has also been identified as a potential contributor to diabetes-related threats to bone health [18].…”