Association Between Bone Mineral Density, Bone Turnover Markers, and Serum Cholesterol Levels in Type 2 Diabetes.

Yinqiu Yang,Mingxiang Yu,Yangli Ye,Yao Zhang,Xinhua Qu,Guangwang Liu,Jun Liang,Xilu Yi,Guiping Xu,Jing Liang,Chenhe Zhao,Chao Ma

doi:10.3389/fendo.2018.00646

Abstract

Purpose: The association between bone mineral density (BMD), bone turnover markers, and serum cholesterol in healthy population has already been proved. However, in patients with type 2 diabetes mellitus (T2D), it has not been adequately analyzed. In this study, we investigated the correlation between BMD, bone turnover markers, and serum cholesterol levels in people with T2D.Methods: We enrolled 1,040 men and 735 women with T2D from Zhongshan Hospital between October 2009 and January 2013. Their general condition, history of diseases and medication, serum markers, and BMD data were collected. We used logistic regression analysis to identify the association between serum cholesterol levels and BMD as well as bone turnover markers.Results: In multivariate regression analysis, we observed that in men with T2D, high high-density lipoprotein-cholesterol and total cholesterol levels were significantly associated with low total lumbar, femur neck, and total hip BMD, while low-density lipoprotein-cholesterol level was only inversely associated with total lumbar and femur neck BMD. Total cholesterol and low-density lipoprotein-cholesterol levels were also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and β-crosslaps. In women with T2D, high-density lipoprotein-cholesterol level was observed to be negatively correlated with total lumbar, femur neck, and total hip BMD, while total cholesterol and low-density lipoprotein-cholesterol levels were only associated with BMD at the total lumbar. Furthermore, total cholesterol was also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and β-crosslaps; high-density lipoprotein-cholesterol was only related to osteocalcin and parathyroid hormone, while low-density lipoprotein-cholesterol was only related to β-crosslaps in women.Conclusion: Our study suggests a significantly negative correlation between serum cholesterol levels and BMD in both men and women with T2D. The associations between serum cholesterol levels and bone turnover markers were also observed in T2D patients.

Highlights

The prevalence of osteoporosis and low-energy fractures in the aging population is increasing, which may lead to disability, poor living quality, and even death [1]
type 2 diabetes mellitus (T2D) was diagnosed based on the Standards of Medical Care in Diabetes by the American Diabetes Association as follows: (a) hemoglobin A1c (HbA1c) ≥6.5%; or (b) fasting blood glucose (FBG) ≥7.0 mmol/L; or (c) 2-h blood glucose ≥11.1 mmol/L by oral glucose tolerance test; or (d) random blood glucose ≥11.1 mmol/L in patients with typical hyperglycemia symptoms or hyperglycemia crisis, which occurs in the absence of unequivocal hyperglycemia, results should be confirmed by repeat testing) [34]
A 1-standard deviation (SD) increases in total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoproteincholesterol (LDL-C) levels were associated with 0.019-g/cm2 (P = 0.0003, 95% confidence intervals (CI) = 0.009–0.029), 0.031g/cm2 (P < 0.0001, 95% CI = 0.021–0.042), and 0.017-g/cm2 (P = 0.0010, 95% CI = 0.007–0.028) decreases in total lumbar bone mineral density (BMD), respectively

Summary

Introduction

The prevalence of osteoporosis and low-energy fractures in the aging population is increasing, which may lead to disability, poor living quality, and even death [1]. The risk factors for osteoporosis in the general population have been reported and analyzed in previous studies [7]. Because of metabolic disorders, the risk factors for osteoporosis in people with T2D may be different, and it is important to discuss them. Several factors are regarded as risk factors for osteoporosis in people with diabetes. Afshinnia et al [8] reported that in patients with diabetes, old age, low body weight, low serum calcium, and low-density lipoprotein cholesterol (LDLC) levels were independently associated with lumbar spine osteoporosis [8]. Chen et al [9] observed that abnormal blood lipid, abnormal adipokine levels, and elevated inflammatory factor levels were independent risk factors for osteoporosis in patients with T2D [9]

Methods

Results

Discussion

Conclusion