Prevalence and predictors of osteopenia and osteoporosis in postmenopausal Chinese women with type 2 diabetes
Introduction
Incidences of osteoporosis and diabetes have dramatically increased in recent decades and they have become one of the major health problems in China [1], [2]. The increasing trend is likely to continue, largely due to the increasing number of old people. Type 2 diabetes mellitus (T2DM) has a high prevalence in aging postmenopausal women. The diabetes is at great risk of the osteoporosis, and the bone fragility unrelated to bone density forms the pathological conditions peculiar to diabetes. There is increasing evidence that patients with T2DM have an increased risk of certain types of osteoporotic fractures. Most studies in women with T2DM have also found an increased risk of hip fractures; with estimates of relative risk almost double the risk in other postmenopausal women [3], [4], [5]. However, little is known about the mechanism of diabetes-related bone fragility and the factors involved in bone abnormality in patients with T2DM.
A major risk factor for osteoporotic fractures is low bone mineral density (BMD), which is under strong genetic control [6], [7], [8]. Studies of BMD in patients with T2DM showed conflicting results. BMD at the forearm in patients with T2DM was decreased, unchanged or even increased in comparison to controls, while BMD at the vertebrae or femoral neck was either not significantly different or increased, but rarely decreased [9], [10], [11], [12]. These complicated results suggest that examining BMDs at different sites may reveal different results, especially in patients with T2DM. On the other hand, there is still some controversy about the risk of osteoporosis in type 2 diabetic patients. In some studies of diabetic patients, dual X-ray absorptiometry (DXA)-based assessment of BMD resulted in a prevalence rate of osteoporosis similar to that for healthy controls [13] and an increased prevalence of osteoporosis in some others [14], [15]. This persistent controversy is probably largely related to the complex pathophysiology of type 2 diabetes, the vast differences in study designs, BMD measurement technology, examination of BMDs at different sites, selection of patients, and the presence or absence of complications.
In most studies there was no consistent relationship between the metabolic control of diabetes and BMD. A meta-analysis demonstrates BMI is a significant predictor of BMD in T2DM [16]. Chinese women have the racial feature that they have lower BMI and prevalence of abdominal obesity than that of the Caucasian women [17], [18]. Chinese type 2 diabetic patients have decreased capacity of insulin secretion and lower insulin sensitivity, from a relatively early stage of the disease [19]. The presence of osteoporosis related to Chinese females with T2DM is less acknowledged and its clinical relevance is less obvious. Thus, we conducted this study to measure the BMD of postmenopausal Chinese women with T2DM at the sites using DXA, and to investigate the relationship between BMD and relevant clinical characteristics in addition to the prevalence of osteoporosis and osteopenia in these postmenopausal women.
Section snippets
Study subjects
Eight hundred and ninety Chinese Han postmenopausal women with type 2 diabetes were included in present study. They were randomly selected from among in-patient and out-patients attending the diabetes clinic of affiliated Hospital of China Medical University during the period between July 2006 and June 2009. The ages of the subjects with diabetes ranged from 50 to 67, with a mean age of 58 years. The inclusion criteria for this study were having been diagnosed with T2DM at the minimum age of 40
Patient characteristics
Table 1 shows clinical characteristics of type 2 diabetic patients and matched control subjects. Age, duration of menopause, age at menopause, and physical activity status were similar between the groups according to the current BMI tertiles. There was no significant difference in serum FSH, LH, ALP, Ca, phosphate, PTH, and calcitonin among the various BMI subgroups. The levels of FPG, 2hPG, and NTx/Cr were significantly higher in type 2 diabetic women than in control subjects (P < 0.05).
Discussion
Bone mass (or bone mineral density) is unmistakably the most important risk factor for osteoporosis and fracture. There are racial differences in bone mass. Asians have lower bone mass than Caucasians, although correcting for body size attenuates these differences [8]. BMD at different sites of the skeleton was reported to correlate with body weight and BMI [22], but there are no previous studies available to compare the risk factors for osteoporosis separately in non-obese and obese elderly
Conflicts of interest statement
There are no conflicts of interest.
Acknowledgements
This study was supported in part by the Grants from the Educational Department of Liaoning Province (#2008810). We are grateful to Dr. Michelle Lin for critical reading of this manuscript. The authors thank our diabetic patients and normal controls for their participation.
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