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Bone Mineral Density Is not Sensitive Enough to Assess the Risk of Vertebral Fractures in Type 2 Diabetic Women

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Abstract

Although the association between diabetes and osteoporosis has been studied, it remains unclear if the pathogenesis of vertebral fractures in patients with type 2 diabetes would be similar to those without diabetes. One hundred and fifty female diabetic patients without apparent proteinuria as well as 716 women without diabetes (control group) were examined by lateral thoracic and lumbar spine radiographs as well as dual-energy X-ray absorptiometry. Vertebral fractures were found in 26 (17.3%) and 158 (22.1%) subjects in the diabetic and control groups, respectively. Diabetic patients had higher absolute and age-matched (Z score) values of lumbar bone mineral density (L-BMD) than controls despite their significantly higher mean age. By receiver operating characteristic (ROC) analysis, the absolute L-BMD values for detecting vertebral fractures were higher and sensitivity and specificity were lower in diabetic patients than controls (0.816 g/cm2 vs. 0.716 g/cm2 and 66.0% vs. 74.8%, respectively). Logistic regression analysis adjusted for age, body weight, and height also showed that L-BMD was not significantly associated with the presence of vertebral fractures in diabetic patients (odds ratio [OR] = 0.61, 95% confidence interval [CI] 0.34–1.09 per standard deviation increase, P = 0.0954), in contrast to the significant association in controls (OR = 0.23, 95% CI 0.16–0.33, P < 0.0001). These results show that L-BMD is not sensitive enough to assess the risk of vertebral fractures in female diabetic patients and suggest that bone fragility not defined by BMD might be related to the risk of vertebral fractures in them.

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References

  1. Krakauer JC, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM (1995) Bone loss and bone turnover in diabetes. Diabetes 44:775–782

    Article  PubMed  CAS  Google Scholar 

  2. Lopez-Ibarra PJ, Pastor MM, Escobar-Jimenez F, Pardo MD, Gonzalez AG, Luna JD, Requena ME, Diosdado MA (2001) Bone mineral density at time of clinical diagnosis of adult-onset type 1 diabetes mellitus. Endocr Pract 7:346–351

    PubMed  CAS  Google Scholar 

  3. McNair P, Christiansen C, Christensen MS, Madsbad S, Faber OK, Binder C, Transbol I (1981) Development of bone mineral loss in insulin-treated diabetes: a 1½ years follow-up study in sixty patients. Eur J Clin Invest 11:55–59

    Article  PubMed  CAS  Google Scholar 

  4. Tuominen JT, Impivaara O, Puukka P, Ronnemaa T (1999) Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 22:1196–1200

    Article  PubMed  CAS  Google Scholar 

  5. Forsen L, Meyer HE, Midthjell K, Edna TH (1999) Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 42:920–925

    Article  PubMed  CAS  Google Scholar 

  6. Nicodemus KK, Folsom AR Iowa Women’s Health Study (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24:1192–1197

    Article  PubMed  CAS  Google Scholar 

  7. Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–1299

    Article  PubMed  CAS  Google Scholar 

  8. Isaia G, Bodrato L, Carlevatto V, Mussetta M, Salamano G, Molinatti GM (1987) Osteoporosis in type II diabetes. Acta Diabetol Lat 24:305–310

    PubMed  CAS  Google Scholar 

  9. Wakasugi M, Wakao R, Tawata M, Gan N, Koizumi K, Onaya T (1993) Bone mineral density measured by dual energy X-ray absorptiometry in patients with non-insulin-dependent diabetes mellitus. Bone 14:29–33

    Article  PubMed  CAS  Google Scholar 

  10. Barrett-Connor E, Holbrook TL (1992) Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 268:3333–3337

    Article  PubMed  CAS  Google Scholar 

  11. Weinstock RS, Goland RS, Shane E, Clemens TL, Lindsay R, Bilezikian JP (1989) Bone mineral density in women with type II diabetes mellitus. J Bone Miner Res 4:97–101

    PubMed  CAS  Google Scholar 

  12. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR; Study of Osteoporotic Features Research Group (2001) Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 86:32–38

    Article  PubMed  CAS  Google Scholar 

  13. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  14. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    PubMed  CAS  Google Scholar 

  15. Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3:120–126

    Article  PubMed  CAS  Google Scholar 

  16. Orimo H, Sugioka Y, Fukunaga M, Mutou Y, Hotokebuchi T, Gorai I, Nakamura T, Kushida K, Tanaka H, Inokai T (1996) Diagnostic criteria for primary osteoporosis in Japan [in Japanese]. Osteoporosis Japan 4:643–653

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    PubMed  CAS  Google Scholar 

  19. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, Therapy (2001) Osteoporosis prevention, diagnosis, and therapy, March 7–29, 2000: highlights of the conference. South Med J 94:569–573

    Google Scholar 

  20. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215

    PubMed  CAS  Google Scholar 

  21. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    PubMed  CAS  Google Scholar 

  22. Nawata H, Soen S, Takayanagi R, Tanaka I, Takaoka K, Fukunaga M, Matsumoto T, Suzuki Y, Tanaka H, Fujiwara S, Miki T, Sagawa A, Nishizawa Y, Seino Y; Subcommittee to Study Diagnostic Criteria for Glucocorticoid-Induced Osteoporosis (2005) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research. J Bone Miner Metab 23:105–109

    Article  PubMed  Google Scholar 

  23. Gerdhem P, Isaksson A, Akesson K, Obrant KJ (2005) Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus. Osteoporos Int 16:1506–1512

    Article  PubMed  CAS  Google Scholar 

  24. Verhaeghe J, van Herck E, Visser WJ, Suiker AM, Thomasset M, Einhorn TA, Faierman E, Bouillon R (1990) Bone and mineral metabolism in BB rats with long-term diabetes. Decreased bone turnover and osteoporosis. Diabetes 39:477–482

    Article  PubMed  CAS  Google Scholar 

  25. Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC (1998) Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone. J Clin Invest 102:274–282

    PubMed  CAS  Google Scholar 

  26. Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP, Portero NR, Meunier PJ (2001) Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 16:97–103

    Article  PubMed  CAS  Google Scholar 

  27. Brownlee M, Cerami A, Vlassara H (1988) Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N Engl J Med 318:1315–1321

    Article  PubMed  CAS  Google Scholar 

  28. Wang X, Shen X, Li X, Agrawal CM (2002) Age-related changes in the collagen network and toughness of bone. Bone 31:1–7

    Article  PubMed  Google Scholar 

  29. Saito M, Fujii K, Marumo K (2006) Degree of mineralization-related collagen crosslinking in the femoral neck cancellous bone in cases of hip fracture and controls. Calcif Tissue Int 79:160–168

    Article  PubMed  CAS  Google Scholar 

  30. Schwartz AV (2003) Diabetes mellitus: does it affect bone? Calcif Tissue Int 73:515–519

    Article  PubMed  CAS  Google Scholar 

  31. Gregg EW, Beckle G, Williams DF, Leveille SG, Langlois JA, Engelgau MM, Narayan KM (2000) Diabetes and physical disability among older U.S. adults. Diabetes Care 23:1272–1277

    Article  CAS  Google Scholar 

  32. Ivers RQ, Cumming RG, Mitchell P, Peduto AJ; Blue Mountains Eye Study (2001) Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care 24:1198–1203

    Article  PubMed  CAS  Google Scholar 

  33. Ahmed LA, Joakimsen RM, Berntsen GK, Fonnebo V, Schirmer H (2005) Diabetes mellitus and the risk of non-vertebral fractures: the Tromso study. Osteoporos Int 10:1–6

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, En-ya-cho, Izumo, Shimane, 693-8501, Japan

    M. Yamamoto, T. Yamaguchi, M. Yamauchi & T. Sugimoto

  2. Divisions of Endocrinology and Metabolism, Neurology, and Hematology and Oncology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    H. Kaji

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  1. M. Yamamoto
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  2. T. Yamaguchi
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  5. T. Sugimoto
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Correspondence to M. Yamamoto.

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Yamamoto, M., Yamaguchi, T., Yamauchi, M. et al. Bone Mineral Density Is not Sensitive Enough to Assess the Risk of Vertebral Fractures in Type 2 Diabetic Women. Calcif Tissue Int 80, 353–358 (2007). https://doi.org/10.1007/s00223-007-9003-7

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  • DOI: https://doi.org/10.1007/s00223-007-9003-7

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