Abstract
BackgroundType 2 diabetes mellitus (T2D) is a complex disease associated with several chronic complications, including bone fragility and high fracture risk due to mechanisms not yet fully understood. The influence of the gastrointestinal tract and its hormones on bone remodeling has been demonstrated in healthy individuals. Glucagon-like peptide 2 (GLP-2), an enteric hormone secreted in response to nutrient intake, has been implicated as a mediator of nutrient effects on bone remodeling. This study aimed to analyze the dynamics of bone resorption marker C-terminal telopeptide of type I collagen (CTX), bone formation marker osteocalcin, and GLP-2 in response to a mixed meal in diabetic postmenopausal women.MethodsForty-three postmenopausal women with osteopenia or osteoporosis (20 controls – group CO – and 23 diabetic – group T2D) were subjected to a standard mixed meal tolerance test, with determination of serum CTX, plasma osteocalcin and serum GLP-2 concentrations at baseline and 30, 60, 120 and 180 minutes after the meal.ResultsT2D women had higher body mass index as well as higher femoral neck and total hip bone mineral density. At baseline, luteinizing hormone, follicle-stimulating hormone, osteocalcin and CTX levels were lower in group T2D. In response to the mixed meal, CTX and osteocalcin levels decreased and GLP-2 levels increased in both groups. The expected CTX suppression in response to the mixed meal was lower in group T2D.ConclusionsBone turnover markers were significantly reduced in T2D women at baseline. Confirming the role of nutrient intake as a stimulating factor, GLP-2 increased in response to the mixed meal in both groups. Importantly, CTX variation in response to the mixed meal was reduced in T2D women, suggesting abnormal response of bone remodeling to nutrient intake in T2D.
Highlights
Despite high bone mineral density (BMD), studies have shown that men and women with type 2 diabetes mellitus (T2D) are at increased risk for fracture, nonvertebral fractures [1,2,3,4,5,6]
The role of the gastrointestinal tract and its hormones, glucagon-like peptide 2 (GLP-2), in bone remodeling has been recently studied in a variety of clinical settings, including healthy volunteers, postmenopausal women and individuals with short bowel syndrome [12,14]
The groups differed in body mass index (BMI), which was greater in group Type 2 diabetes mellitus (T2D) (30 ± 3.9 vs. 27 ± 5.3 kg/m2, p = 0.044), and in femoral neck and total hip BMD, which were higher in group T2D (Table 1)
Summary
Despite high bone mineral density (BMD), studies have shown that men and women with type 2 diabetes mellitus (T2D) are at increased risk for fracture, nonvertebral fractures [1,2,3,4,5,6]. The role of the gastrointestinal tract and its hormones, glucagon-like peptide 2 (GLP-2), in bone remodeling has been recently studied in a variety of clinical settings, including healthy volunteers, postmenopausal women and individuals with short bowel syndrome [12,14]. Another relevant issue is the reciprocal influence between bone and energy metabolism, that has been described involving osteocalcin, insulin and leptin [15]. This study aimed to analyze the dynamics of bone resorption marker C-terminal telopeptide of type I collagen (CTX), bone formation marker osteocalcin, and GLP-2 in response to a mixed meal in diabetic postmenopausal women
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