Abstract
Background and aims: Type 2 diabetes mellitus (DM) has a high prevalence in aging obese postmenopausal women. It is not clear whether or not diabetes produces an increase in bone mineral density or an increase in fracture rates. Objective: The main objective of this study was to investigate whether type 2 DM produces a higher prevalence of vertebral, hip and non-vertebral fractures in obese postmenopausal Caucasian women. A secondary objective was to study the influence of DM in quantitative ultrasound measurements of the heel (QUS) and bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA), in both lumbar spine (L2–L4) and proximal femur. Method: This study was a prospective cohort of 111 patients with type 2 DM and 91 control individuals (CTR) over age 65 and obese, recruited from 16 centers in Spain. Main Outcome Measures: Lateral dorsal and lumbar X-rays were performed to assess vertebral fractures. Hip and non-vertebral fractures were noted from medical records, written reports or X-ray studies. QUS measurements were made of the calcaneus and BMD measurements of the lumbar spine (L2–L4) and proximal femur. Results: Patients had higher BMD in the lumbar spine (L2–L4) than controls (0.979 g/cm2 vs 0.927 g/cm2, p=0.035), but we found no statistically significant differences in the proximal femur. QUS measurements showed similar values in both groups: BUA (69.3 dB/Mhz vs 66.7 dB/Mhz, p=0.291), SOS (1537 m/sg vs 1532 m/sg, p=0.249) and QUI (87.5 vs 83.7, p=0.153). No statistically significant differences were found in any case. There was no association between vertebral, hip and non-vertebral fractures and DM. The crude odds ratio, without adjusting was 1.045 (CI 957o 0.531; 2.059), and the adjusted odds ratio was 0.927 (CI 95% 0.461; 1.863). Conclusions: In obese postmenopausal Caucasian women, type 2 DM produces an increase in BMD of the lumbar spine without changes in BMD of the proximal femur or in QUS measurements of the heel. The prevalence of vertebral, hip and non-vertebral fractures did not increase in type 2 DM.
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References
McNair P. Bone mineral metabolism in human type I (insulin dependent) diabetes mellitus. Dan Med Bull 1988; 35: 109–21.
Barrett-Connor E, Holbrook TL. Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 1992; 268: 3333–7.
De Leeuw I, Abs R. Bone mass and bone density in maturity-type diabetics measured by the Iodine-125 photon-absorption technique. Diabetes 1977; 26: 1130–5.
Meema HE, Meema S. The relationship of diabetes mellitus and body weight to osteoporosis in elderly females. Can Med Assoc J 1967; 96: 132–9.
Dennison EM, Syddall HE, Aihie Sayer A, Craighead S, Phillips DIW, Cooper C. Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance? Diabetologia 2004; 47: 1963–8.
Bauer DC, Browner WS, Cauley JA et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993; 118: 657–65.
Levin ME, Boisseau VC, Avioli LV. Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes. N Engl J Med 1976; 294: 241–5.
Ishida H, Seino Y, Matsukura S et al. Diabetic osteopenia and circulating levels of vitamin D metabolites in type 2 (noninsulin-dependent) diabetes. Metabolism 1985; 34: 797–801.
Isaia G, Bodrato L, Carlevatto V, Mussetta M, Salamano G, Molinatti GM. Osteoporosis in type II diabetes. Acta Diabetol Lat 1987; 24: 305–10.
Giacca A, Fassina A, Caviezel F, Cattaneo AG, Caldirola G, Pozza G. Bone mineral density in diabetes mellitus. Bone 1988; 9: 29–36.
Sosa M, Domínguez M, Navarro MC et al. Bone mineral metabolism is normal in non-insulin dependent diabetes mellitus. J Diabetes Complicat 1996; 10: 201–5.
Wakasugi M, Wakao R, Tawata M, Gan N, Koizumi K, Onaya T. Bone mineral density measured by dual energy X-ray absorptiometry in patients with non-insulin-dependent diabetes mellitus. Bone 1993; 14: 29–33.
Heath H 3rd, Melton LJ 3rd, Chu CP. Diabetes mellitus and risk of skeletal fracture. N Engl J Med 1980; 303: 567–70.
Melchior TM, Sorensen H, Torp-Pedersen C. Hip and distal arm fracture rates in peri- and postmenopausal insulin-treated diabetic females. J Intern Med 1994; 236: 203–8.
Cummings SR, Nevitt MC, Browner WS et al. Risk factors for hip fracture in white women: Study of Osteoporotic Fractures Research Group. N Engl J Med 1995; 332: 767–73.
Seeley DG, Kelsey J, Jergas M, Nevitt MC. Predictors of ankle and foot fractures in older women: the Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1996; 11: 1347–55.
Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR. Risk factors for fractures of the distal forearm and proximal humerus: the Study of Osteoporotic Fractures Research Group. Am J Epidemiol 1992; 135: 477–89.
Forsen L, Meyer HE, Midthjell K, Edna TH. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 1999; 42: 920–5.
Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 1993; 137: 1203–11.
Dobnig H, Piswanger-Sölkner JC, Roth M et al. Type 2 diabetes mellitus in nursing home patients: Effects on bone turnover, bone mass, and fracture risk. J Clin Endocrinol Metab 2006: 91: 3355–63.
World Health Organisation Scientific Group Research on the Menopause. 1998 WHO Technical Services Report Series 670. WHO, Geneva.
Díaz Curiel M, Carrasco de la Peña JL, Honorato Pérez J, Pérez Cano R, Rapado A, Ruiz Martínez I. Study of bone mineral density in lumbar spine and femoral neck in a Spanish population. Osteoporos Int 1997; 7: 59–64.
Sosa M, Saavedra P, Muñoz-Torres M et al, and the GIUMO Study Group. Quantitative ultrasound calcaneus measurements: normative data and precision in Spanish population. Osteoporos Int 2002; 13: 487–92.
Genant HK. Assessment of vertebral fractures in osteoporosis research. J Rheumatol 1997; 24: 1212–4.
Guglielmi G, Brett A, Haslam J, Walker K, Placentino MG, Catalano F. Vertebral assessment by plain X-ray film: accuracy and precision of an automatic software. Oral presentation at 11th Meeting of the European Society of Musculoskeletal Radiology, June 2004, Augsburg, Germany.
McNair P, Christensen MS, Madsbad S, Christiansen C, Transbol I. Hyperparathyroidism in diabetes mellitus. Acta Endocrinol 1981; 96: 81–6.
Gregorio F, Cristallini S, Santeusanio F, Filipponi P, Fumelli P. Osteopenia associated with non-insulin-dependent diabetes mellitus: what are the causes? Diabetes Res Clin Pract 1984; 23: 43–54.
De Liefde II, Van der Klift M, De Laet CEDH, Van Daele PLA, Hofman A, Pols HAP. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 2005; 16: 1713–20.
Lunt M, Masaryk P, Scheidt-Nave C et al. The effects of lifestyle, dietary dairy intake and diabetes on bone density and vertebral deformity prevalence: The EVOS Study. Osteoporos Int 2001; 12: 688–98.
Gerdhem P, Isaksson A, Akesson K, Obrant KJ. Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus. Osteoporos Int 2005; 16: 1506–12.
Schwartz AV, Sellmeyer DE, Ensrud KE et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2005; 86: 32–8.
Schwartz AV, Sellmeyer DE, Strotmeyer ES et al. Diabetes and bone loss at the hip in older black and white adults. J Bone Miner Res 2005; 20: 596–603.
Strotmeyer ES, Cauley JA, Schwartz AV et al. Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the health, aging, and body composition study. J Bone Miner Res 2004; 19: 1084–91.
Espallarges M, Sampietro-Colom L, Estrada MD, Sola M, del Rio L, Setoain J, Granados A. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporos Int 2001; 12: 811–22.
Gerdhem P, Ringsberg KAM, Obrant KJ, Akesson K. Association between 25-hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population-based OPRA Study of Elderly Women. Osteoporos Int 2005; 16: 1425–31.
Nathan DM, Buse JB, Davidson MB et al. Management of hyperglycemia in type 2 Diabetes: A Consensus Algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006; 29: 1963–72.
Schwartz AV. Diabetes mellitus: does it affect bone? Calcif Tissue Int 2003; 73: 515–9.
Glüer CC, for the International Quantitative Ultrasound Consensus Group. Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. J Bone Miner Res 1997; 12: 1280–8.
Njeh CF, Fuerst T, Diessel E, Genant HK. Is quantitative ultrasound dependent on bone structure? A reflection. Osteoporos Int 2001; 12: 1–15.
Cummings SR, Bates D, Black DM. Clinical use of bone densitometry. Scientific Review. JAMA 2002; 288: 1889–97.
Steiger P, Cummings SR, Black DM, Spencer NE, Genant HK. Age-related decrements in bone mineral density in women over 65. J Bone Miner Res 1992; 7: 625–32.
Livers RQ, Cumming RG, Mitchell P, Peduto AJ. Diabetes and risk of fracture. The Blue Mountain-Eye Study. Diabetes Care 2001; 24: 1198–203.
Krakauer JC, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM. Bone loss and bone turnover in diabetes. Diabetes 1995; 44: 775–82.
Strotmeyer ES, Cauley JA, Schwartz AV et al. Non-traumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults. Arch Intern Med 2005; 165: 1612–7.
Agnusdei D. Bone quality. Aging Clin Exp Res. 2004; 16 (Suppl): 1–2.
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Sosa, M., Saavedra, P., Jódar, E. et al. Bone mineral density and risk of fractures in aging, obese post-menopausal women with type 2 diabetes. The GIUMO Study. Aging Clin Exp Res 21, 27–32 (2009). https://doi.org/10.1007/BF03324895
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DOI: https://doi.org/10.1007/BF03324895