Abstract
BackgroundWomen with type 2 diabetes mellitus (T2DM) have a higher risk of fractures despite increased bone mineral density (BMD). In experimental studies a potential role of plasminogen activator inhibitor-1 (PAI-1) in bone remodeling is suggested but studies in humans are lacking. This is a first study in humans investigating whether circulated levels of PAI-1 in postmenopausal women with T2DM are related to BMD and adiposity.MethodsAnthropometric variables, PAI-1 and insulin levels, serum lipids and bone turnover markers were measured in 127 postmenopausal women with T2DM. A total of 117 female patients were divided according to lumbar spine BMD measurements via dual-energy x-ray absorptiometry in three groups: 47 with osteopenia, 21 with osteoporosis and 49 with normal BMD.ResultsDiabetic patients with normal BMD had significantly higher BMI, greater waist circumference and lower bone turnover markers than diabetics with osteopenia and osteoporosis. PAI-1 was lower in diabetics with osteoporosis and osteopenia compared with diabetics with normal BMD. Multiple regression analysis revealed insulin, triglycerides levels, pyrilinks and beta blocker therapy to be the strongest predictors of PAI-1 levels. PAI-1 levels correlated with both L-BMD and hip BMD, but after adjustment for age and BMI association was no longer significant.ConclusionOur findings suggest that elevated PAI-1 levels are associated with higher BMD in obese diabetic patients but the possible implications of this finding and underlying mechanisms still remain unclear. Obviously, metabolic parameters, may affect both BMD and PAI-levels, and association of PAI-1 and BMD could be indirect. However, as pyrilinks is also independently and significantly negatively correlated to PAI-1 its direct involvement in bone metabolism is also plausible. Further investigations are needed to elucidate the nature of interaction of this matrix modulator in relation to energy and bone metabolism in humans.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0094-x) contains supplementary material, which is available to authorized users.
Highlights
Women with type 2 diabetes mellitus (T2DM) have a higher risk of fractures despite increased bone mineral density (BMD)
A total of 117 diabetic patients were divided according to lumbar spine BMD measurements (L-BMD) measurements in three groups: 47 with osteopenia (T-score between −1 to −2,5), 21 with osteoporosis (T-score ≤ −2,5) and 49 with normal BMD (T-score ≥ −1)
Our research demonstrated that postmenopausal female patients with diabetes type 2 and normal BMD had signficantly lower bone turnover markers and higher body mass index (BMI) compared to diabetic subjects with osteoporosis/osteopenia indicating lower rate of bone turnover in obese subjects
Summary
Women with type 2 diabetes mellitus (T2DM) have a higher risk of fractures despite increased bone mineral density (BMD). In experimental studies a potential role of plasminogen activator inhibitor-1 (PAI-1) in bone remodeling is suggested but studies in humans are lacking This is a first study in humans investigating whether circulated levels of PAI-1 in postmenopausal women with T2DM are related to BMD and adiposity. The aim of this study was to investigate whether circulated levels of PAI-1 in postmenopausal women with T2DM are related to BMD and adiposity To our knowledge this is a first study performed on human subjects with osteoporosis and diabetes type 2 including patients with long-term diabetes who have received standard care according to American Diabetes Association (ADA) guidelines [14], all medications were carefully recorded and the possible role of the subsequent modification of inflammation/coagulation was investigated
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