Skip to main content

Advertisement

SpringerLink
Log in

Volumetric bone mineral density of the spine predicts mortality in African-American men with type 2 diabetes

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

The study showed that in African-American men with type 2 diabetes mellitus (T2D), vertebral volumetric bone mineral density (vBMD) predicts all-cause mortality, independent of other risk factors for death.

Introduction

Compared to European Americans, African Americans have lower rates of osteoporosis and higher rates of T2D. The relationships between BMD and fractures with mortality are unknown in this population. The aim of this study was to determine relationships between vertebral fractures and vertebral vBMD and mortality in African Americans with T2D.

Methods

Associations between vertebral fractures and vBMD with all-cause mortality were examined in 675 participants with T2D (391 women and 284 men) in the African American-Diabetes Heart Study (AA-DHS). Lumbar and thoracic vBMD were measured using quantitative computed tomography (QCT). Vertebral fractures were assessed on sagittal CT images. Associations of vertebral fractures and vBMD with all-cause mortality were determined in sex-stratified analyses and in the full sample. Covariates in a minimally adjusted model included age, sex, BMI, smoking, and alcohol use; the full model was adjusted for those variables plus cardiovascular disease, hypertension, coronary artery calcified plaque, hormone replacement therapy (women), African ancestry proportion, and eGFR.

Results

After mean 7.6 ± 1.8-year follow-up, 59 (15.1%) of women and 58 (20.4%) of men died. In men, vBMD was inversely associated with mortality in the fully adjusted model: lumbar hazard ratio (HR) per standard deviation (SD) = 0.70 (95% CI 0.52–0.95, p = 0.02) and thoracic HR per SD = 0.71 (95% CI 0.54–0.92, p = 0.01). Only trends toward association between vBMD and mortality were observed in the combined sample of men and women, as significant associations were absent in women. Vertebral fractures were not associated with mortality in either sex.

Conclusions

Lower vBMD was associated with increased all-cause mortality in African-American men with T2D, independent of other risk factors for mortality including subclinical atherosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166(5):495–505

    Article  PubMed  Google Scholar 

  2. Schwartz AV, Vittinghoff E, Bauer DC, Study of Osteoporotic Fractures (SOF) Research Group. Osteoporotic Fractures in Men (MrOS) Research Group. Health, Aging, and Body Composition (Health ABC) Research Group et al (2011) Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 305(21):2184–2192

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Dubey A, Aharonoff GB, Zuckerman JD, Koval KJ (2000) The effects of diabetes on outcome after hip fracture. Bull Hosp Jt Dis 59(2):94–98

    PubMed  CAS  Google Scholar 

  4. Huang YF, Shyu YI, Liang J, Chen MC, Cheng HS, Wu CC (2012) Diabetes and health outcomes among older Taiwanese with hip fracture. Rejuvenation Res 15(5):476–482

    Article  PubMed  Google Scholar 

  5. Muraki S, Yamamoto S, Ishibashi H, Nakamura K (2006) Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 24(2):100–104

    Article  PubMed  Google Scholar 

  6. Miyake H, Kanazawa I, Sugimoto T (2018) Association of bone mineral density, bone turnover markers, and vertebral fractures with all-cause mortality in type 2 diabetes mellitus. Calcif Tissue Int 102(1):1–13

    Article  PubMed  CAS  Google Scholar 

  7. Cauley JA (2011) Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res 469(7):1891–1899

    Article  PubMed  PubMed Central  Google Scholar 

  8. Menke A, Casagrande S, Geiss L, Cowie CC (2015) Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA 314:1021–1029

    Article  PubMed  CAS  Google Scholar 

  9. Freedman BI, Divers J, Russell GB, Palmer ND, Wagenknecht LE, Smith SC, Xu J, Carr JJ, Bowden DW, Register TC (2015) Vitamin D associations with renal, bone, and cardiovascular phenotypes: African American-Diabetes Heart Study. J Clin Endocrinol Metab 100(10):3693–3701

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Freedman BI, Langefeld CD, Lu L, Palmer ND, Carrie Smith S, Bagwell BM, Hicks PJ, Xu J, Wagenknecht LE, Raffield LM, Register TC, Jeffrey Carr J, Bowden DW, Divers J (2015) APOL1 associations with nephropathy, atherosclerosis, and all-cause mortality in African Americans with type 2 diabetes. Kidney Int 87(1):176–181

    Article  PubMed  CAS  Google Scholar 

  11. Register TC, Lenchik L, Hsu FC, Lohman KK, Freedman BI, Bowden DW, Carr JJ (2006) Type 2 diabetes is not independently associated with spinal trabecular volumetric bone mineral density measured by QCT in the Diabetes Heart Study. Bone 39(3):628–633

    Article  PubMed  CAS  Google Scholar 

  12. Lenchik L, Shi R, Register TC, Beck SR, Langefeld CD, Carr JJ (2004) Measurement of trabecular bone mineral density in the thoracic spine using cardiac gated quantitative computed tomography. J Comput Assist Tomogr 28(1):134–139

    Article  PubMed  Google Scholar 

  13. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148

    Article  PubMed  CAS  Google Scholar 

  14. Agarwal S, Cox AJ, Herrington DM, Jorgensen NW, Xu J, Freedman BI, Carr JJ, Bowden DW (2013) Coronary calcium score predicts cardiovascular mortality in diabetes: diabetes heart study. Diabetes Care 36(4):972–977

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Krishna A, Razak F, Lebel A, Davey Smith G, Subramanian SV (2015) Trends in group inequalities and interindividual inequalities in BMI in the United States, 1993-2012. Am J Clin Nutr 101(3):598–605

    Article  PubMed  CAS  Google Scholar 

  16. Mussolino ME, Gillum RF (2008) Low bone mineral density and mortality in men and women: the Third National Health and Nutrition Examination Survey linked mortality file. Ann Epidemiol 18(11):847–850

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bliuc D, Alarkawi D, Nguyen TV, Eisman JA, Center JR (2015) Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res 30(4):637–646

    Article  PubMed  Google Scholar 

  18. Campos-Obando N, Castano-Betancourt MC, Oei L, Franco OH, Stricker BHC, Brusselle GG, Lahousse L, Hofman A, Tiemeier H, Rivadeneira F, Uitterlinden AG, Zillikens MC (2014) Bone mineral density and chronic lung disease mortality: the Rotterdam study. J Clin Endocrinol Metab 99(5):1834–1842

    Article  PubMed  CAS  Google Scholar 

  19. Johansson H, Odén A, Kanis J, McCloskey E, Lorentzon M, Ljunggren Ö, Karlsson MK, Orwoll E, Tivesten Å, Ohlsson C, Mellström D (2011) Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int 22(5):1411–1418

    Article  PubMed  CAS  Google Scholar 

  20. Suzuki T, Yoshida H (2010) Low bone mineral density at femoral neck is a predictor of increased mortality in elderly Japanese women. Osteoporos Int 21(1):71–79

    Article  PubMed  CAS  Google Scholar 

  21. Van Der Klift M, Pols HA, Geleijnse JM et al (2002) Bone mineral density and mortality in elderly men and women: the Rotterdam Study. Bone 30(4):643–648

    Article  Google Scholar 

  22. Trivedi DP, Khaw KT (2001) Bone mineral density at the hip predicts mortality in elderly men. Osteoporos Int 12(4):259–265

    Article  PubMed  CAS  Google Scholar 

  23. Qu X, Huang X, Jin F, Wang H, Hao Y, Tang T, Dai K (2013) Bone mineral density and all-cause, cardiovascular and stroke mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 166(2):385–393

    Article  PubMed  Google Scholar 

  24. Buckens CF, van der Graaf Y, Verkooijen HM, Mali WP, Isgum I, Mol CP, Verhaar HJ, Vliegenthart R, Oudkerk M, van Aalst CM, de Koning HJ, de Jong PA (2015) Osteoporosis markers on low-dose lung cancer screening chest computed tomography scans predict all-cause mortality. Eur Radiol 25(1):132–139

    Article  PubMed  CAS  Google Scholar 

  25. Lenchik L, Register TC, Hsu FC, Xu J, Smith SC, Carr JJ, Freedman BI, Bowden DW (2017) Bone mineral density of the radius predicts all-cause mortality in patients with type 2 diabetes: Diabetes Heart Study. J Clin Densitom Dec 1 [Epub ahead of print]

  26. Ma L, Oei L, Jiang L, Estrada K, Chen H, Wang Z, Yu Q, Zillikens MC, Gao X, Rivadeneira F (2012) Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol 27(5):319–332

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Schwartz AV, Sellmeyer DE, Strotmeyer ES, Tylavsky FA, Feingold KR, Resnick HE, Shorr RI, Nevitt MC, Black DM, Cauley JA, Cummings SR, Harris TB, Health ABC Study (2005) Diabetes and bone loss at the hip in older black and white adults. J Bone Miner Res 20(4):596–603

    Article  PubMed  Google Scholar 

  28. Ochs-Balcom HM, Preus L, Wactawski-Wende J, Nie J, Johnson NA, Zakharia F, Tang H, Carlson C, Carty C, Chen Z, Hoffman T, Hutter CM, Jackson RD, Kaplan RC, Li L, Liu S, Neuhouser ML, Peters U, Robbins J, Seldin MF, Thornton TA, Thompson CL, Kooperberg C, Sucheston LE (2013) Association of DXA-derived bone mineral density and fat mass with African ancestry. J Clin Endocrinol Metab 98(4):E713–E717

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Divers J, Palmer ND, Langefeld CD, Brown WM, Lu L, Hicks PJ, Smith SC, Xu J, Terry JG, Register TC, Wagenknecht LE, Parks JS, Ma L, Chan GC, Buxbaum SG, Correa A, Musani S, Wilson JG, Taylor HA, Bowden DW, Carr JJ, Freedman BI (2017) Genome-wide association study of coronary artery calcified atherosclerotic plaque in African Americans with type 2 diabetes. BMC Genet 18(1):105

    Article  PubMed  PubMed Central  Google Scholar 

  30. Raffield LM, Hsu FC, Cox AJ, Carr JJ, Freedman BI, Bowden DW (2015) Predictors of all-cause and cardiovascular disease mortality in type 2 diabetes: Diabetes Heart Study. Diabetol Metab Syndr 7:58

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Cox AJ, Hsu FC, Agarwal S, Freedman BI, Herrington DM, Carr JJ, Bowden DW (2014) Prediction of mortality using a multi-bed vascular calcification score in the Diabetes Heart Study. Cardiovasc Diabetol 13:160

    Article  PubMed  PubMed Central  Google Scholar 

  32. Divers J, Register TC, Langefeld CD, Wagenknecht LE, Bowden DW, Carr JJ, Hightower RC, Xu J, Hruska KA, Freedman BI (2011) Relationships between calcified atherosclerotic plaque and bone mineral density in African Americans with type 2 diabetes. J Bone Min Res 26:1554–1560

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported by NIH grants: 2R01 DK071891 (BIF) and HL67348 (DWB).

Author information

Authors and Affiliations

  1. Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1053, USA

    L. Lenchik

  2. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    T.C. Register

  3. Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    G.B. Russell & J. Divers

  4. Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA

    J. Xu, S.C. Smith & D.W. Bowden

  5. Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    B.I. Freedman

Authors
  1. L. Lenchik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T.C. Register
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G.B. Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S.C. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D.W. Bowden
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Divers
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B.I. Freedman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Lenchik.

Ethics declarations

The study was approved by the WFSM Institutional Review Board and all participants provided written informed consent.

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenchik, L., Register, T., Russell, G. et al. Volumetric bone mineral density of the spine predicts mortality in African-American men with type 2 diabetes. Osteoporos Int 29, 2049–2057 (2018). https://doi.org/10.1007/s00198-018-4578-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-018-4578-6

Keywords

Search

Navigation