Correlations between bone mineral density and circulating bone metabolic markers in diabetic patients
Introduction
Since Albright and Reifensten pointed out a reduction in bone mineral in diabetic patients with poor glycemic control in 1948 [1], there have been many clinical studies reporting that osteopenia is one of the chronic complications associated with diabetes mellitus. In patients with non-insulin-dependent diabetes mellitus (NIDDM), however, there have been conflicting observations concerning the incidence of osteopenia, depending on the differences in sex, age and race or the methods to detect the decrease in bone mineral density [2], [3], [4], [5], [6], [7], [8]. In the present study, we assessed the bone mineral content in male NIDDM patients and their age-matched healthy subjects using methods of computed X-ray densitometry (CXD) [9], which can measure the bone density in the cortical bone of metacarpus. In addition, the correlations between the measured bone mineral content and circulating levels of bone metabolic markers, such as serum calcium, magnesium, parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP), and urinary excretion of calcium were also measured in order to clarify the underlying pathophysiology of diabetic osteopenia in NIDDM.
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Subjects
A total of 104 male NIDDM patients (54.0±1.0 years old and 5.6±0.6 years of disease duration; mean±S.E.M.) was examined in this study. One-hundred and eight age-matched male healthy subjects (51.6±0.9 years old) were also studied as the controls (Table 1). The female NIDDM patients and healthy subjects were excluded from the present study to prevent the influences of sex hormones from the evaluation of bone mineral content [10]. Those who had obvious renal dysfunction (serum creatinine levels
Measurement of bone mineral density
Teijin Bonalyzer (Teijin Co. Ltd., Tokyo, Japan) was utilized to measure the bone mineral density by means of CXD at the center of the right second metacarpal bone [11]. The principle of this method is based on the microdensitometric method using X-ray films of hands with an aluminum step scale [4], [12], using which we have previously conducted a clinical survey on diabetic osteopenia in NIDDM patients [4]. The index corresponding to bone mineral content (m-BMD) [13] was obtained as the
Bone mineral content obtained by CXD method
The values of m-BMD by CXD method were calculated to be 2.60±0.03 mmA1 in male NIDDM patients, which were significantly smaller than those of the age-matched controls, 2.81±0.04 mmAl (P<0.01). In addition, the decrease of m-BMD was significant at each decade from 40 to 60 years old, as shown in Table 2 (P<0.01 in their forties and fifties, and P<0.05 in their sixties).
Z(m-BMD) values in male NIDDM patients were revealed to be −0.94±0.19 (mean±S.E.), ranging from −9.40 to +3.50. When compared
Discussion
There have been several reports concerning the prevalence and pathogenetic mechanism of bone mass loss in NIDDM patients [2], [3], [4], [5], [6], [7], [8], but a diversity in race, sex, age and methods for measurement or sites selected for the quantification of mineral content makes the results controversial. Z(m-BMD) values of metacarpal bone density in the CXD method were found to be significantly decreased in NIDDM patients. On the other hand, no statistical difference was observed in the
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