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Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus

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Abstract

Summary

We found that type 2 diabetes mellitus (T2DM) was associated with increased fracture risks in non-obese postmenopausal Chinese women, and suppressed bone turnover might be the underlying mechanism. This is the first study evaluating and explaining the association of T2DM with osteoporotic fracture in Chinese population with such high homogeneity.

Introduction

The aim of this study was to investigate the association of T2DM with osteoporotic fracture in postmenopausal Chinese women.

Methods

One thousand four hundred ten postmenopausal women were included and stratified into non-obese population [body mass index (BMI) < 25 kg/m2] and obese population (BMI ≥ 25 kg/m2). Each type of population was classified into diabetes group, impaired fasting glucose (IFG) group, and normal glucose group. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum C-terminal telopeptide of type I collagen (β-CTX) and serum N-amino terminal prepeptide of type 1 procollagen (P1NP) were quantified. Vertebral fractures (VFs) and non-VFs were assessed by vertebral X-ray and questionnaire, respectively.

Results

Comparing to normal glucose group, diabetes group and IFG group both had lower levels of P1NP and β-CTX, despite population types. Despite having non-decreased BMD, non-obese diabetic patients had higher risks of total fracture and VF than BMI-matched normal glucose subjects (both P < 0.05). Non-obese population was further classified by a mean value of P1NP or β-CTX. Non-obese diabetic patients with low P1NP or high β-CTX had higher fracture risks (both P < 0.05), comparing to non-obese normal glucose subjects with high P1NP or high β-CTX, respectively.

Conclusions

Type 2 diabetic patients had suppressed bone turnover, which might explain the increased fracture risks, independent of BMD. IFG patients might also have poor bone quality and need early prevention.

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Acknowledgments

Our deepest gratitude to all the study participants and to the participating centers of the original parent study: Department of Endocrinology, China Rehabilitation Research Center; Department of Endocrinology, Beijing Liangxiang Hospital; Department of Cadre Unit, General Hospital of the Second Artillery Force; Department of Endocrinology, Peking University Shougang Hospital; Department of Endocrinology, Beijing Chaoyang Hospital, Capital University of Medical Science; Department of Endocrinology, Beijing Haidian Hospital; and Department of Geriatric Endocrinology, Chinese People’s Liberation Army, General Hospital. We would also like to thank Ms. Yingying Hu for her valuable doing of biomarker testing procedures. This study was funded by the National Natural Science Foundation of China (Nos. 81070687 and 81170805), National Science and Technology Pillar Program (2006BAI02B03), National Science and Technology Major Projects for “Major New Drugs Innovation and Development” (Grant No. 2008ZX09312-016), Beijing Natural Science Foundation (No. 7121012), Scientific Research Foundation of Beijing Medical Development (No. 2007-3029), and National Key Program of Clinical Science (WBYZ2011-873).

Conflicts of interest

All the authors of this article, including Ruizhi Jiajue, Yan Jiang, Ou Wang, Mei Li, Xiaoping Xing, Liqiang Cui, Jinhua Yin, Ling Xu, and Weibo Xia, declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, China

    R. Jiajue, Y. Jiang, O. Wang, M. Li, X. Xing, L. Cui, J. Yin & W. Xia

  2. Department of Endocrinology, The First Affiliated Hospital, Shanxi Medical University, Taiyuan, Shanxi, China

    J. Yin

  3. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, China

    L. Xu

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  1. R. Jiajue
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  2. Y. Jiang
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  4. M. Li
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  9. W. Xia
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Correspondence to W. Xia.

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Jiajue, R., Jiang, Y., Wang, O. et al. Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus. Osteoporos Int 25, 1999–2005 (2014). https://doi.org/10.1007/s00198-014-2714-5

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  • DOI: https://doi.org/10.1007/s00198-014-2714-5

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