Abstract
Aim of the study: To examine the bone mineral density (BMD) in Bulgarian patients with type 1 diabetes mellitus (DM) in comparison to age- sex- and ethnically matched healthy controls and its correlation with bone turnover markers: oteocalcin as a marker of bone formation and deoxypyridinoline cross-laps as bone resorption marker. Materials and methods: 162 patients with type 1 DM (97 females and 65 males) age 29.17 yrs. (20-40) and 200 (100 women and 100 men) age- and sex matched healthy controls were analyzed for BMD and Z-score of lumbar spine and femoral neck by dual X-ray absorptiometry (DXA) using Lunar DPX-A. Plasma levels of osteocalcin and urine levels of deoxypyridinoline cross-laps were determined. Results: BMD in type 1 DM showed statistically significant lower levels for lumbar spine L1-L4- men (1.2114 g/ cm2 ± 0,1587 DM vs. 1.3346 g/ cm2 ± 0,1635 controls, P<0.05) and L1-L4 women (1.1035 g/cm2 ± 0.1269 DM vs 1.1978 g/ cm2 ± 0,1269 controls, P<0.05) and femoral neck - men (0.9138 g/cm2 ± 2134 DM vs 0.9868 g/ cm2 ± 0.1534 controls, P<0.05) and women (0.8656 g/cm2 ± 0.1223 DM vs 0.9236 g/ cm2 ± 0.145 controls, P<0.05) in both sexes in comparison with that in control group. We found no statistically significant difference for osteocalcin levels as a marker of bone formation in both groups (P=0.062), while deohypyridinoline (DPD) levels as a marker of bone resorption were significantly higher (P<0.01) in diabetic patients in comparison with age and sex matched controls. Osteocalcin showed significant negative correlation with BMD at lumbar spine (r=-0.418; P=0.004) and nonsignificant negative correlation with that at femoral neck (r=-0.271; P=0.078) in diabetic patients. DPD showed nonsignificant correlations with BMD at lumbar spine (r=-0.024; P=0.846) and at femoral neck (r=0.143; P=0.259) in diabetic patients. Conclusions: BMD measured at lumbar spine and femoral neck was significantly lower in patients with type 1 DM than in age-and sex matched controls. Levels of the bone turnover markers indicate increased bone resorption as a reason for the decreased bone mineral content in diabetic patients. Prospective studies are needed to determine whether metabolic control of diabetes has any influence upon the observed bone changes and whether keeping good metabolic control can minimize the reduction of the bone mineral content like it happens with the diabetic microangioapthy. If we consider the reduction of the BMD to be a specific complication of type 1 diabetes mellitus than we should take appropriate measures to cope with this problem like stressing upon the importance of appropriate diet adequate physical activity especially at the time peak bone mass is being accumulated.
Highlights
In 2004 the prevalence of diabetes mellitus (DM) for all age-groups worldwide was estimated to reach 4.4% with 366 million suffering from the disease in 2030 [1]
Our data showed that observed low bone mineral density in diabetic patients was associated with increased bone resorption
Osteocalcin levels showed statistically significant negative correlation with the bone mineral density (BMD) of lumbar spine built up mainly of cancellous bone with high metabolic activity and nonsignificant negative one with the BMD of femoral neck suggesting an unsuccessful attempt of osteoblasts to compensate for the increased bone resorption
Summary
In 2004 the prevalence of diabetes mellitus (DM) for all age-groups worldwide was estimated to reach 4.4% with 366 million suffering from the disease in 2030 [1]. Patients with type 1 diabetes accounts for 5-10% of those with diabetes [3] At their majority these are young active people and with the expected increase in the absolute number and the life expectancy of patients with DM on the forefront comes the risk of developing complications different than that typical for the disease and so far considered of no such great importance, like diabetic bone changes for example. Additional factors in diabetic osteopenia can be important like impaired blood perfusion to bone due to macroangiopathy and decreased mechanical stress on bone, due to neuropathy and myopathy [17] Another reason for diabetic osteopenia in type 1 DM can be accumulated low peak bone mass during puberty partly due to osteoblast dysfunction, partly to the specific requirements of the diabetic diet and reduced physical activity. Diabetes mellitus type 1 is associated with reduced bone mineral density while in different studies patients with type 2 are found to have normal, Received January 26, 2014; Accepted February 24, 2014; Published February 27, 2014
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