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Assessment of the osteoporosis risk in patients with type 2 diabetes mellitus – when bone mineral density measurement is not sufficient

Czech version

Authors: Peter Jackuliak;  Magdaléna Kovářová;  Martin Kužma;  Juraj Payer
Authors‘ workplace: V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava
Published in: Forum Diab 2021; 10(1): 10-16
Category:

Overview

Introduction: Osteoporosis is an increasingly widespread disease, as well as diabetes mellitus. It is now accepted that osteoporotic fractures are a serious co-morbidity and complication of diabetes. The risk of fracture is elevated in patients with Type 1 Diabetes (T1DM), in which bone mineral density is reduced, but also in Type 2 Diabetes (T2DM) patients, in which is the change of bone quality. Objective: To determine changes in bone mineral density (BMD) in patients with T1DM and T2DM, and to compare these changes with the control group without diabetes. Patients and methods: We analyzed a cohort of postmenopausal women with diabetes and a matched control group. The cohort consisted of 145 women, 76 of whom had diabetes mellitus (25 with T1DM, 51 with T2DM), and 69 were without glucose metabolism. For all patients, central bone density (spinal and lumbar spine) was tested by DXA methodology, glycemic control parameters were assessed, and anthropometric parameters were measured. Bone quality was analyzed using TBS software. We then processed the results statistically. Results: In T1DM was the BMD significantly (p = 0.01) lower than in control group (LS: 0.71 ± 0.13 g/cm2 vs. 0.98 ± 0.13 g/cm2; hip: 0.61 ± 0.10 g/cm2 vs. 0.81 ± 0.13 g/cm2). Patients with T2DM had a higher BMD than patients with T1DM (LS: 0.91 ± 0.16 g/cm2 vs. 0.71 ± 0.13 g/cm2; hip: 0.79 ± 0.17 g/cm2 vs. 0.61 ± 0.13 g/cm2). There was no difference between BMD in T2DM versus the control group. Patients with T1DM had a higher incidence of osteoporosis (35 % versus 11 %) compared to patients with T2DM. In diabetes with T2DM up to 76 % had osteopenia. Conclusion: We confirmed that postmenopausal women with T1DM have significantly reduced bone mineral density compared to the control group. Patients with T2DM have higher BMD than T1DM, results of BMD are comparable to non-diabetic population. This fact makes it difficult to identify risk groups (for osteoporotic fractures) in T2DM. Therefore, other modalities, to improve the risk assessment of osteoporosis in T2DM, are discussed. One of them is the combination of densitometry and trabecular bone score.

Keywords:

bone quality – diabetes mellitus – fractures – glycemic compensation – osteoporosis

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Labels
Diabetology Endocrinology Internal medicine
Osteoporosis in endocrinopathies
Osteoporosis management in diabetic patient
Contribution of metformin therapy with extended release formulas
De-intensification of treatment in patient with diabetes mellitus could be beneficial
Population differences in the prevalence of diabetes mellitus, its risk factors and complications
Second generation basal insulin analogues in clinical trials using continuous monitoring of glucose levels
Practical experience confirms the results of the RCT and RWE studies with empagliflosin: case reports
Diabetic macular oedema treatment with intravitreal dexamethasone: case report
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