High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study - PubMed (original) (raw)

. 2013 Jun;36(6):1619-28.

doi: 10.2337/dc12-1188. Epub 2013 Jan 11.

M Carola Zillikens, Abbas Dehghan, Gabriëlle H S Buitendijk, Martha C Castaño-Betancourt, Karol Estrada, Lisette Stolk, Edwin H G Oei, Joyce B J van Meurs, Joseph A M J L Janssen, Albert Hofman, Johannes P T M van Leeuwen, Jacqueline C M Witteman, Huibert A P Pols, André G Uitterlinden, Caroline C W Klaver, Oscar H Franco, Fernando Rivadeneira

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High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study

Ling Oei et al. Diabetes Care. 2013 Jun.

Abstract

Objective: Individuals with type 2 diabetes have increased fracture risk despite higher bone mineral density (BMD). Our aim was to examine the influence of glucose control on skeletal complications.

Research design and methods: Data of 4,135 participants of the Rotterdam Study, a prospective population-based cohort, were available (mean follow-up 12.2 years). At baseline, 420 participants with type 2 diabetes were classified by glucose control (according to HbA1c calculated from fructosamine), resulting in three comparison groups: adequately controlled diabetes (ACD; n = 203; HbA1c <7.5%), inadequately controlled diabetes (ICD; n = 217; HbA1c ≥ 7.5%), and no diabetes (n = 3,715). Models adjusted for sex, age, height, and weight (and femoral neck BMD) were used to test for differences in bone parameters and fracture risk (hazard ratio [HR] [95% CI]).

Results: The ICD group had 1.1-5.6% higher BMD, 4.6-5.6% thicker cortices, and -1.2 to -1.8% narrower femoral necks than ACD and ND, respectively. Participants with ICD had 47-62% higher fracture risk than individuals without diabetes (HR 1.47 [1.12-1.92]) and ACD (1.62 [1.09-2.40]), whereas those with ACD had a risk similar to those without diabetes (0.91 [0.67-1.23]).

Conclusions: Poor glycemic control in type 2 diabetes is associated with fracture risk, high BMD, and thicker femoral cortices in narrower bones. We postulate that fragility in apparently "strong" bones in ICD can result from microcrack accumulation and/or cortical porosity, reflecting impaired bone repair.

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Figures

Figure 1

Figure 1

Adjusted means of narrow neck width (A) and cortical thickness (B) in relation to glucose control by age tertiles: youngest, 55.0–63.6 years of age; middle, 63.6–71.4 years of age; oldest, >71.4 years of age. Kaplan-Meier curve per comparison group showing the adjusted cumulative hazards for fracture using follow-up time as timescale (C). Cox proportional hazard model: ICD vs. no diabetes HR 1.47 (95% CI 1.12–1.92), P = 0.005; ACD vs. no diabetes HR 0.91 (0.67–1.23), P = 0.54. Cumulative HR adjusted for femoral neck BMD, age, sex, height, and weight. Light gray, ND; dark gray or dashed, ACD; black, ICD.

Figure 1

Figure 1

Adjusted means of narrow neck width (A) and cortical thickness (B) in relation to glucose control by age tertiles: youngest, 55.0–63.6 years of age; middle, 63.6–71.4 years of age; oldest, >71.4 years of age. Kaplan-Meier curve per comparison group showing the adjusted cumulative hazards for fracture using follow-up time as timescale (C). Cox proportional hazard model: ICD vs. no diabetes HR 1.47 (95% CI 1.12–1.92), P = 0.005; ACD vs. no diabetes HR 0.91 (0.67–1.23), P = 0.54. Cumulative HR adjusted for femoral neck BMD, age, sex, height, and weight. Light gray, ND; dark gray or dashed, ACD; black, ICD.

Figure 2

Figure 2

Cartoon depicting the differences in bone geometry across glucose control groups for a cross-section of the femoral neck. Individuals with ICD have thicker cortices and narrower neck width than those without diabetes and ACD. With lower instability of cortical bone (lower buckling ratios), the accumulation of microcracks and cortical porosity becomes a possibility to explain bone fragility and fracture susceptibility. Drawing is not to scale.

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References

    1. National Diabetes Statistics [article online], 2011. Available from http://diabetes.niddk.nih.gov/dm/pubs/statistics/ Accessed 1 July 2011
    1. DECODE Study Group. Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care 2003;26:61–69 - PubMed
    1. Ström O, Borgström F, Kanis J, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations. Arch Osteoporos 2011;6:59–155 - PubMed
    1. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 2007;166:495–505 - PubMed
    1. Schwartz AV, Vittinghoff E, Bauer DC, et al. Study of Osteoporotic Fractures (SOF) Research Group. Osteoporotic Fractures in Men (MrOS) Research Group. Health, Aging, and Body Composition (Health ABC) Research Group Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 2011;305:2184–2192 - PMC - PubMed

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