Bone mass and strength in older men with type 2 diabetes: the Osteoporotic Fractures in Men Study

Moira A Petit, Misti L Paudel, Brent C Taylor, Julie M Hughes, Elsa S Strotmeyer, Ann V Schwartz, Jane A Cauley, Joseph M Zmuda, Andrew R Hoffman, Kristine E Ensrud, Osteoporotic Fractures in Men (MrOs) Study Group, Moira A Petit, Misti L Paudel, Brent C Taylor, Julie M Hughes, Elsa S Strotmeyer, Ann V Schwartz, Jane A Cauley, Joseph M Zmuda, Andrew R Hoffman, Kristine E Ensrud, Osteoporotic Fractures in Men (MrOs) Study Group

Abstract

The effects of type 2 diabetes mellitus (T2DM) on bone volumetric density, bone geometry, and estimates of bone strength are not well established. We used peripheral quantitative computed tomography (pQCT) to compare tibial and radial bone volumetric density (vBMD, mg/cm(3)), total (ToA, mm(2)) and cortical (CoA, mm(2)) bone area and estimates of bone compressive and bending strength in a subset (n = 1171) of men (> or =65 years of age) who participated in the multisite Osteoporotic Fractures in Men (MrOS) study. Analysis of covariance-adjusted bone data for clinic site, age, and limb length (model 1) and further adjusted for body weight (model 2) were used to compare data between participants with (n = 190) and without (n = 981) T2DM. At both the distal tibia and radius, patients with T2DM had greater bone vBMD (+2% to +4%, model 1, p < .05) and a smaller bone area (ToA -1% to -4%, model 2, p < .05). The higher vBMD compensated for lower bone area, resulting in no differences in estimated compressive bone strength at the distal trabecular bone regions. At the mostly cortical bone midshaft sites of the radius and tibia, men with T2DM had lower ToA (-1% to -3%, p < .05), resulting in lower bone bending strength at both sites after adjusting for body weight (-2% to -5%, p < .05) despite the lack of difference in cortical vBMD at these sites. These data demonstrate that older men with T2DM have bone strength that is low relative to body weight at the cortical-rich midshaft of the radius despite no difference in cortical vBMD.

Copyright 2010 American Society for Bone and Mineral Research.

References

    1. Schwartz AV, Sellmeyer DE. Women, type 2 diabetes, and fracture risk. Curr Diab Rep. 2004;4:364–369.
    1. 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. 2001;24:1192–1197.
    1. Vestergaard P. Discrepencies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: a meta-analysis. Osteoporos Int. 2007;18:427–444.
    1. Strotmeyer ES, Cauley JA. Diabetes mellitus, bone mineral density, and fracture risk. Curr Opin Endocrinol Diabetes Obes. 2007;14:429–435.
    1. Rakel A, Sheehy O, Rahme E, Lelorier J. Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab. 2008 [Epub ahead of print]
    1. Bray GA, Bellanger T. Epidemiology, trends and morbidities of obesity and metabolic syndrome. Endocrine. 2006;29:109–117.
    1. Krakauer JC, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM. Bone loss and bone turnover in diabetes. Diabetes Res Clin Pract. 1995;44:775–782.
    1. 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. 1994;23:43–54.
    1. Schwartz AV. Diabetes mellitus: does it affect bone? Calcif Tissue Int. 2003;73:515–519.
    1. Ahmad T, Ohlsson C, Saaf M, Ostenson C-G, Kriecbergs A. Skeletal changes in type 2 diabetic Goto-Kakizaki rats. J Endocrinol. 2003;178:111–116.
    1. Beck TJ. On measuring bone to predict osteoporotic fracture: moving beyond statistical inference. Radiology. 1996;199:612–614.
    1. Saito M, Fujii K, Mori Y, Marumo K. Role of collagen enzymatic and gycation-induced cross-slinks as a determinant of bone quality in spontaneously diabetic WBN/Kob rats. Ostoporos Int. 2006;17:1514–1523.
    1. Jarvinen TL, Sievanen H, Jokihaara J, Einhorn TA. Revival of bone strength: the bottom line. J Bone Miner Res. 2005;20:717–720.
    1. Petit MA, Beck TJ, Kontulainen SA. Examining the developing bone: what do we measure and how do we do it? J Musculoskel Neuron Interact. 2005;5:213–224.
    1. Ferretti Jl, Capozza RF, Zanchetta JR. Mechanical validation of a tomographic (pQCT) index for noninvasive. Bone. 1996;18:97–102.
    1. Register TC, Lenchik L, Hsu T-C, et al. Type 2 diabetes is not independently associated with spinal trabecular volumetric bone mineral density measured by QCT in the Diabetes Heart Study. Bone. 2006;39:312–319.
    1. Strotmeyer ES, Cauley JA, Schwartz AV, et al. Diabetes is associated independently of body composition with BMD and bone volume in older while and black men and women: the Health, Agining, and Body Composition Study. J Bone Miner Res. 2004;19:1084–1091.
    1. Ahmad T, Ohlsson C, Ostenson C-G, Kreicbergs A. Peripheral quantitative computed tomography for the detection of diabetic ostopathy: a study in the Goto-Kakizaki rat. Invest Radiol. 2003;38:171–176.
    1. Orwoll ES, Blank JB, Barrett-Connor E, et al. Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study: a large observational study of the determinants of fracture in older men. Contemp Clin Trials. 2005;26:569–585.
    1. Blank JB, Cawthon PM, Carrion-Petersen ML, et al. Overview of recruitment for the osteoporotic fractures in men study (MrOS) Contemp Clin Trials. 2005;26:557–568.
    1. Cauley JA, Fullman RL, Stone KL, et al. Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int. 2005;16:1525–1537.
    1. Harkonen R, Harju R, Alaranta H. Accuracy of the Jamar dynamometer. J Hand Ther. 1993;6:259–262.
    1. Washburn RA, Flicker JL. Physical Activity Scale for the Elderly (PASE): the relationship with activity measured by a portable accelerometer. J Sports Med Phys Fitness. 1999;39:336–340.
    1. Strotmeyer ES, Marshall LM, Schwartz AV, et al. Higher bone mineral density in older men with diabetes and impaired fasting glucose: the Osteoporotic Fractures in Men Study. Diabetes. 2007;56:A259.
    1. Schwartz AV, Sellmeyer DE. Diabetes, fracture and bone fragility. Curr Osteoporos Rep. 2007;5:105–111.
    1. Schwartz AV, Hiller TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25:1749–1754.
    1. Volpato S, Leveille SG, Blaum C, Fried LP, Guralink JM. Risk factors for falls in older disabled women with diabetes: the women's health and aging study. J Gerontol A Biol Sci Med Sci. 2005;60:1539–1545.
    1. Hayes WC, Myers ER, Robinovitch SN, et al. Etiology and prevention of age-related hip fractures. Bone. 1996;18:77S–86S.
    1. Beck T. Measuring the structural strength of bones with dual-energy X-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int. 2003;14:S81–S88.
    1. Hofbauer LC, Brueck CC, Singh SK, Dobnig H. Osteoporosis in patients with diabetes mellitus. J Bone Miner Res. 2007;22:1317–1328.
    1. Rigalleau V, Lasseur C, Raffaitin C, et al. Bone loss in diabetic patients with chronic kidney disease. Diabetes Med. 2007;24:91–93.
    1. Rix M, Andreassen H, Eskildsen P. Impact of peripheral neuropathy on bone density in patients with type 1 diabetes. Diabetes Care. 1999;22:827–831.
    1. Looker AC, Flegal KM, Melton L., Jr. Impact of increased overweight on the projected prevalence of osteoporosis in older women. Ostoporos Int. 2007;18:307–313.
    1. Petit MA, Beck TJ, Shults J, Zemel BS, Foster B, Leonard MB. Proximal femur bone geometry is appropriately adapted to lean mass in overweight children and adolescents. Bone. 2005;36:568–576.
    1. Goulding A, Taylor RW, Jones IE, McAuley KA, Manning PJ, Williams SM. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord. 2000;24:627–632.
    1. Beck TJ, Chen Z, Petit MA, Wu G, LeBoff MS. Does obesity really make the femur stronger? Bone mineral density, geometry and fracture incidence in the Women's Health Initiative—observational study. J Bone Miner Res. 2009;24:1369–1379.
    1. Thomas T, Burguerra B, Melton LJI, et al. Role of serum leptin, insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women. Bone. 2001;29:114–120.
    1. Lenchik L, Register TC, Hsu FC, et al. Adiponectin as a novel determinant of bone mineral density and visceral fat. Bone. 2003;33:646–651.
    1. Thommesen L, Stunes AK, Monjo M, et al. Expression and regulation of resistin in osteoblasts and osteoclasts indicate a role in bone metabolism. J Cell Biochem. 2006;99:824–834.
    1. Turner CH, Robling AG. Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev. 2003;31:45–50.
    1. Zhang L, Liu Y, Wang D, Zhao X, Qiu Z, Ji H, Rong H. Bone biomechanical and histomorphometrical investment in type 2 diabetic Goto-Kakizaki rats. Acta Diabetol. 2008 [Epub ahead of print]
    1. Schurman L, McCarthy AD, Sedlinsky C, et al. Metformin reverts deleterious effects of advance glycation end-products (AGEs) on osteoblastic cells. Exp Clin Endocrinol Diabetes. 2008 [Epub ahead of print]
    1. Watts NB, D'Alessio DA. Type 2 diabetes, thiazolinediones: bad to the bone? J Clin Endocrinol Metab. 2006;91:3276–3278.
    1. Grey A. Skeletal consequences of thiazolidinedione therapy. Osteoporos Int. 2008;19:129–137.
    1. Jokihaara J, Jarvinen TL, Jolma P, et al. Renal insufficiency-induced bone loss is associated with an increase in bone size and preservation of strength in rat proximal femur. Bone. 2006;39:353–360.
    1. Asano M, Fukui M, et al. Bone stiffness in men with type 2 diabetes mellitus. Metabolism. 2008;57:1691–1695.

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