Skip to main content

Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus

Journal of Bone and Mineral Metabolism volume 37, pages 503–511 (2019)Cite this article

Abstract

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fragility fracture. However, whether diabetes-related osteoporosis independently contributes to the deterioration of activities of daily living (ADLs) and quality of life (QOL) is unclear. This cross-sectional study investigated the association between osteoporosis, ADLs, and QOL in 309 patients with T2DM. ADLs and QOL were assessed using Barthel Index (BI) and a SF-36 questionnaire. Multiple logistic regression analyses adjusted for age, gender, T2DM duration, body mass index, hemoglobin A1c, estimated GFR, diabetic neuropathy, retinopathy, nephropathy, cardiovascular disease, cerebrovascular disease, peripheral artery disease, and anti-diabetic treatments were conducted. The number of patients with osteoporosis or vertebral fracture was 166 (53.7%) and 118 (38.2%), respectively. Osteoporosis was significantly associated with lower general health (GH), social functioning (SF), and role emotional (RE) (OR 2.56, 1.79, and 1.92, respectively; all p values < 0.05 at least) and marginally associated with lower BI (OR 2.39, p = 0.068). Moreover, the presence of vertebral fracture grade 2 or 3 was significantly associated with lower BI, bodily pain (BP), GH, vitality, SF, and RE (OR 2.58, 2.01, 3.64, 1.99, 2.18, and 1.97, respectively; all p values < 0.05 at least). Osteoporosis and severe vertebral fracture were associated with the deterioration of ADLs and QOL independently of other diabetic complications. Therefore, the management of diabetes-related osteoporosis is an important strategy to avoid the deterioration of ADLs and QOL in T2DM.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Abbreviations

ADLs:

Activities of daily living

BI:

Barthel Index

BMD:

Bone mineral density

BMI:

Body mass index

BP:

Bodily pain

eGFR:

Estimated glomerular filtration rate

GH:

General health

HbA1c:

Hemoglobin A1c

MH:

Mental health

PAD:

Peripheral arery disease

PF:

Physical functioning

RE:

Role emotional

RP:

Role physical

SF:

Social functioning

QOL:

Quality of life

T2DM:

Type 2 diabetes mellitus

VT:

Vitality

YAM:

Young adult mean

References

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

    Article  Google Scholar 

  2. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444

    Article  CAS  PubMed  Google Scholar 

  3. Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2009) Diabetic patients have an increased risk of vertebral fractures independent of bone mineral density or diabetic complications. J Bone Miner Res 24:702–709

    Article  CAS  PubMed  Google Scholar 

  4. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ensrund KE, Thompson DE, Cauley JA, Nevitt MC, Kado DM, Hochberg MC, Santora AC 2nd, Black DM (2009) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. J Am Geriatr Soc 48:241–249

    Article  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 102:1–13

    Article  CAS  PubMed  Google Scholar 

  7. Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16:447–455

    Article  PubMed  Google Scholar 

  8. Cauley JA, Lui LY, Paudel ML, Taylor BC, Cawthon PM, Hillier TA, Schousboe JT, McCulloch CE, Ensrud KE (2016) Impact of radiographic vertebral fractures on inpatient healthcare utilization in older women. Bone 88:165–169

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yamaguchi T, Sugimoto T, Yamada H, Kanzawa M, YanoS Yamauchi M, Chihara K (2002) The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int 13:331–336

    Article  CAS  PubMed  Google Scholar 

  10. Yamaguchi T, Sugimoto T, Yamauchi M, Matsumori Y, Tsutsumi M, Chihara K (2005) Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women. J Bone Miner Metab 23:36–40

    Article  PubMed  Google Scholar 

  11. Trikkalinou A, Papazafiropoulou AK, Melidonis A (2017) Type 2 diabetes and quality of life. World J Diabetes 8:120–129

    Article  PubMed  PubMed Central  Google Scholar 

  12. Adriaanse MC, Drewes HW, van der Heide I, Struijs JN, Baan CA (2016) The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res 25:175–182

    Article  PubMed  Google Scholar 

  13. Solli O, Stavem K, Kristiansen IS (2010) Health-related quality of life in diabetes: the associations of complications with EQ-5D scores. Health Qual Life Outcomes 8:18

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yasuda H, Sanada M, Kitada K, Terashima T, Kim H, Sakaue Y, Fujitani M, Kawai H, Maeda K, Kashiwagi A (2007) Rationale and usefulness of newly devised abbreviated diagnostic criteria and staging for diabetic polyneuropathy. Diabetes Res Clin Pract 77(Suppl 1):S178–S183

    Article  CAS  PubMed  Google Scholar 

  15. Inomat S, Haneda M, Morita T, Katayama S, Iwamoto Y, Sakai H, Tomino Y, Matsuo S, Asano Y, Makino H, Committee Diabetic Nephropha (2005) Revised criteria for the early diagnosis of diabetic nephropathy. Nihon Jinzo Gakkai Shi 47:767–769

    PubMed  Google Scholar 

  16. Soen S, Fukunaga M, Sugimoto T, Sone T, Fujiwara S, Endo N, Gorai I, Shiraki M, Hagino H, Hosoi T, Ohta H, Yoneda T, Tomomitsu T, Japanese Society for Bone and Mineral Research and Japan Osteoporosis Society Joint Review Committee for the Revision of the Diagnostic Criteria for Primary Osteoporosis (2013) Diagnostic criteria for primary osteoporosis: year 2012 revision. J Bone Miner Metab 31:247–257

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  19. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  20. Ware JE Jr (2000) SF-36 health survey update. Spine 25:3130–3139

    Article  PubMed  Google Scholar 

  21. Kanis JA, Minne HW, Meunier PJ, Ziegler R, Allender E (1992) Quality of life and vertebral osteoporosis. Osteoporos Int 2:161–163

    Article  CAS  PubMed  Google Scholar 

  22. Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis JA (2000) Health related quality of life (HRQOL) in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392

    Article  CAS  PubMed  Google Scholar 

  23. Oleksik AM, Ewing S, Shen W, van Schoor NM, Lips P (2005) Impact of incident vertebral fractures on health related quality of life (HRQOL) in postmenopausal women with prevalent vertebral fractures. Osteoporos Int 16:861–870

    Article  PubMed  Google Scholar 

  24. Rostom S, Allali F, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2012) Phychometric properties evaluation of the quality of life questionnaire of the European Foundation for osteoporosis in Arabic population. Rheumatol Int 32:2037–2049

    Article  PubMed  Google Scholar 

  25. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH (2004) Diabetes, depression, and quality of life: a population study. Diabetes Care 27:1066–1070

    Article  PubMed  Google Scholar 

  26. Gavard JA, Lustman PJ, Clouse RE (1993) Prevalence of depression in adults with diabetes. An epidemiological evaluation. Diabetes Care 16:1167–1178

    Article  CAS  PubMed  Google Scholar 

  27. Rose M, Fliege H, Hildebrandt M, Schirop T, Klapp BF (2002) The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care 25:35–42

    Article  PubMed  Google Scholar 

  28. Wilson S, Sharp CA, Davie MWJ (2012) Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture: a systematic review. Osteoporos Int 23:2749–2768

    Article  CAS  PubMed  Google Scholar 

  29. Bianchi ML, Orsini MR, Saraifoger S, Ortolani S, Radaelli G, Betti S (2005) Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes 3:78

    Article  PubMed  PubMed Central  Google Scholar 

  30. de Oliveria Ferreira N, Arthuso M, da Silva R, Pedro AO, Pinto Neto AM, Costa-Paiva L (2009) Quality of life in women with postmenopausal osteoporosis: correlation between QUALEFFO 41 and SF-36. Maturitas 62:85–90

    Article  Google Scholar 

  31. Andersen H, Nielsen S, Mogensen CE, Jakobsen J (2004) Muscle strength in type 2 diabetes. Diabetes 53:1543–1547

    Article  CAS  PubMed  Google Scholar 

  32. Park SW, Goodpaster BH, Lee JS, Kuller LH, Boudreau R, de Rekeneire N, Harris TB, Kritchevsky S, Tylavsky FA, Nevitt M, Cho YW, Newman AB, Health, Aging, and Body composition Study (2009) Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 32:1993–1997

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hirshfeld HP, Kinsella R, Duque G (2017) Osteosarcopenia: where bone, muscle, and fat collide. Osteoporos Int 28:2781–2790

    Article  CAS  Google Scholar 

  34. Huang CY, Liao LC, Tong KM, Lai HL, Chen WK, Chen CI, Lu CY, Chen FJ (2015) Mediating effects on health-related quality of life in adults with osteoporosis: a structural equation modeling. Osteoporos Int 26:875–883

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the patients and hospital staff who participated in this study. This study was funded by the Japan Osteoporosis Foundation and partly supported by research Grant from Eli Lilly Japan. I.K. is fully responsible for the content of the manuscript.

Funding

This study was funded by the Japan Osteoporosis Foundation.

Author information

Authors and Affiliations

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

    Ippei Kanazawa, Ayumu Takeno, Ken-ichiro Tanaka & Toshitsugu Sugimoto

  2. Masuda Red Cross Hospital, Masuda, Japan

    Ayumu Takeno & Ken-ichiro Tanaka

  3. Yamane Hospital, Hamada, Japan

    Yuko Yamane

Authors
  1. Ippei Kanazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayumu Takeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken-ichiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuko Yamane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshitsugu Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

IK collected and analysed the data and prepared the manuscript. AT, KT, and YY collected the data. TS contributed to the discussion and reviewed the manuscript. All authors participated in the preparation of the manuscript and approved its final version for publication.

Corresponding author

Correspondence to Ippei Kanazawa.

Ethics declarations

Conflict of interest

Ippei Kanazawa, Ayumu Takeno, Ken-ichiro Tanaka, Yuko Yamane and Toshitsugu Sugimoto declare that they have no conflicts of interest.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kanazawa, I., Takeno, A., Tanaka, Ki. et al. Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus. J Bone Miner Metab 37, 503–511 (2019). https://doi.org/10.1007/s00774-018-0948-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-018-0948-6

Keywords

  • Type 2 diabetes mellitus
  • Osteoporosis
  • Vertebral fracture
  • ADLs
  • QOL