Determinants of Low Bone Turnover in Type 2 Diabetes-the Role of PTH

Janina Vavanikunnel, Lilian Sewing, Maria Triantafyllidou, Anna Steighardt, Sandra Baumann, Andrea Egger, Leticia Grize, Barbara Felix, Marius Kraenzlin, Christoph Henzen, Christian Meier, Janina Vavanikunnel, Lilian Sewing, Maria Triantafyllidou, Anna Steighardt, Sandra Baumann, Andrea Egger, Leticia Grize, Barbara Felix, Marius Kraenzlin, Christoph Henzen, Christian Meier

Abstract

Determinants of low bone turnover in type 2 diabetes (T2DM) are poorly understood. To investigate the relationship between markers of bone turnover, glycaemic control, disease duration and calciotropic hormones in T2DM we assessed baseline biochemical data from the DiabOS Study, a prospective multicenter observational cohort study. In a cross-sectional study-design data from 110 postmenopausal women and men aged 50-75 years diagnosed with T2DM for at least 3 years and 92 non-diabetic controls were evaluated. Biochemical markers of bone formation (N-terminal propeptide of type I procollagen [PINP]), bone-specific alkaline phosphatase [BAP]) and resorption (C-terminal cross-linking telopeptide of type I collagen [CTX]), measures of calcium homeostasis (intact parathormone [iPTH], 25-Hydroxyvitamin D, calcium, magnesium) and glycaemic control were assessed. After adjustment for age, gender and body mass index (BMI), patients with T2DM had lower serum levels of PINP (p < 0.001), CTX (p < 0.001), iPTH (p = 0.03) and magnesium (p < 0.001) compared to controls. Serum calcium, creatinine, 25-Hydroxyvitamin D and sclerostin did not differ between both groups. In multivariate linear regression analyses only serum iPTH remained an independent determinant of bone turnover markers in T2DM (PINP: p = 0.02; CTX: p < 0.001 and BAP: p < 0.01), whereas glycated haemoglobin (HbA1c), disease duration, age and BMI were not associated with bone turnover. In conclusion low bone turnover in T2DM is associated with low iPTH. The underlying mechanism remains to be elucidated.

Keywords: Bone turnover; Diabetes; Hypoparathyroidism.

Conflict of interest statement

Janina Vavanikunnel, Lilian Sewing, Maria Triantafyllidou, Anna Steighardt, Sandra Baumann, Andrea Egger, Leticia Grize, Barbara Felix, Marius Kraenzlin, Christoph Henzen, Christian Meier authors state that they have no conflicts of interest with respect to the submitted manuscript.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Distribution of serum PINP and CTX levels in T2DM (n = 110) and non-diabetic controls (Co) (n = 88)
Fig. 2
Fig. 2
Distribution of serum intact PTH levels in T2DM (n = 108) and non-diabetic controls (n = 88)
Fig. 3
Fig. 3
Distribution of serum magnesium levels in T2DM (n = 108) and non-diabetic controls (n = 89)

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