Clinical and pathogenetic significance of comorbid osteoporosis in diabetes mellitus in women with menopause

Abstract

Background. Osteoporosis is a serious problem due to the high morbidity, mortality and significant costs for medical care. Moreover, in women in the menopausal period, bone fragility due to osteoporosis is more pronounced, and osteoporotic vertebral fractures are three times more common than in men. Type 2 diabetes mellitus (DM) is closely associated with osteoporosis, and some hormonal and peptide markers of bone metabolism simultaneously determine bone mineralization and the state of carbohydrate metabolism. The purpose was to assess the course of diabetes in women during menopause and to study the clinical and pathogenetic relationship with the presence of osteoporosis in them. Materials and methods. Two hundred and sixty-one women with menopause were examined. They were divided into two groups: 17 % with DM (main one) and 83 % without DM (comparison group). In 51 % of cases, osteoporosis was diagnosed (osteopenia and osteoporosis ratio was 4 : 1). The study of carbohydrate metabolism included the determination of insulin resistance HOMA index and the severity of metabolic syndrome, blood levels of insulin, glucose, glycosylated hemoglobin and C-peptide, and markers of bone metabolism were serum parameters of parathyroid hormone, calcitonin, osteocalcin, osteopontin, alkaline phosphatase activity, chemical elements (Ca, P, Mg, Co, Cr, Cu, Mn, Pb, Se, Sr, Zn). Results. DM was diagnosed in 34 % of women with osteoporosis, which directly correlates with their age, frequency and severity of other signs of metabolic syndrome (hyperinsulinemia, hyperlipidemia, hyperuricemia, arterial hypertension, obesity), the absence of cases of normal lipidemia and type IIA lipid metabolism disorders, but with the prevalence of type IIB, a higher rate of alkaline phosphatase activity in the blood and lower values of osteopontin and selenium. Besides, DM severity is closely related to the parameters of mineral bone density and phosphatemia level, and the development of diabetic retinopathy, nephropathy and peripheral macro-/microangiopathy, respectively, depends on the content of selenium, zinc and osteopontin, and the rate of calcemia has prognostic significance. Conclusions. The pathogenetic significance of comorbid osteoporosis, parameters of bone mineral density and markers of bone metabolism in the blood serum of women with menopause in the development of DM, the severity of its course and complications has been proven, and the indicators of osteopontin, calcium, selenium and zinc have prognostic significance.