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Menopausal bone changes and incident fractures in diabetic women: a cohort study

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Abstract

Summary

The purpose of this study was to evaluate the rate of bone loss and incident fractures in women with diabetes mellitus (DM) across menopause. During menopause, DM women experienced bone mineral density (BMD) loss that was faster at hip and slower at spine and had a higher risk of fractures, perhaps because of their earlier menopause. The increasing DM epidemic will contribute to higher fracture burden.

Introduction

Women with DM have a higher risk of fractures independent of age, body mass index (BMI), and BMD. Our objective is to evaluate if women with DM experience greater bone loss and more fractures across menopause.

Methods

Two thousand one hundred seventy one women, aged 42 to 52 years at baseline (1996), enrolled in the Study of Women's Health Across the Nation (SWAN), a prospective study, with 8 years of annual follow up. One thousand three hundred forty six (62%) completed annual visit 7 (2004). Women with baseline fasting blood glucose level of ≥126 mg/dl and those being treated for diabetes were designated as DM. Annual assessment of menopausal stage, BMD, and urinary N-telopeptide (NTx) were carried out. Rate of change in BMD across menopause and annual self-report data for risk of incident fractures by DM status were determined.

Results

Despite higher baseline BMD at hip (p = <0.001), and lumbar spine (p = <0.001), rate of decline in BMD was faster at hip (β = −0.45 vs. −0.11 gm/cm2/year, p = <0.001) for DM women, compared to non-DM. However, lumbar spine bone loss was slower in women with DM as compared to non-DM women (β = 0.04 vs. −0.25 gm/cm2/year, p = 0.004). DM women experienced menopause 3 years earlier than non-DM women (p = 0.002), and age adjusted incident fractures were two fold higher in women with DM compared to non-DM (RR = 2.20, 95% CI: 1.26–3.85, p = <0.006).

Conclusions

BMD loss is greater in hip and slower at spine in DM women during menopausal transition. Women with DM have a higher risk of fractures, perhaps because of their earlier menopause.

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Acknowledgments

The SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.

Clinical Centers: University of Michigan, Ann Arbor, MaryFran Sowers, PI; Massachusetts General Hospital, Boston, MA, Robert Neer, PI 1994–1999; Joel Finkelstein, PI 1999– present; Rush University, Rush University Medical Center, Chicago, IL, Lynda Powell, PI 1994–2009; Howard Kravitz, PI 2009; University of California, Davis/Kaiser, Ellen Gold, PI; University of California, Los Angeles, Gail Greendale, PI; University of Medicine and Dentistry, New Jersey Medical School, Newark, Gerson Weiss, PI 1994–2004; Nanette Santoro, PI 2004–present; and the University of Pittsburgh, Pittsburgh, PA, Karen Matthews, PI.

NIH Program Office: National Institute on Aging, Bethesda, MD, Marcia Ory 1994–2001; Sherry Sherman 1994–present; National Institute of Nursing Research, Bethesda, MD, Program Officers.

Central Laboratory: University of Michigan, Ann Arbor, Daniel McConnell (Central Ligand Assay Satellite Services).

Coordinating Center: New England Research Institutes, Watertown, MA, Sonja McKinlay, PI 1995–2001; University of Pittsburgh, Pittsburgh, PA, Kim Sutton-Tyrrell, PI 2001–present.

Steering Committee: Chris Gallagher, Chair; Susan Johnson, Chair

We thank the study staff at each site and all the women who participated in SWAN.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA

    N. Khalil

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    K. Sutton-Tyrrell, E. S. Strotmeyer, M. Vuga, F. Selzer & J. A. Cauley

  3. Division of General Internal Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    C. J. Crandall

  4. Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    G. A. Greendale

  5. Assistant Professor Environmental Health Center for Global Health Systems, Management, and Policy Boonshoft School of Medicine, Wright State University, 3123 Research Blvd., Suite 200, Kettering, OH, 45420, USA

    N. Khalil

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  1. N. Khalil
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Correspondence to N. Khalil.

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Khalil, N., Sutton-Tyrrell, K., Strotmeyer, E.S. et al. Menopausal bone changes and incident fractures in diabetic women: a cohort study. Osteoporos Int 22, 1367–1376 (2011). https://doi.org/10.1007/s00198-010-1357-4

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