Abstract Details

Session title: Type 2 diabetes

Session type: Poster - Diabetes in Women and Children

Track: Diabetes in Women and Children

Presentation number: P-1013

Abstract title:
Bone mineral density and metabolic bone indices in Asian Indian postmenopausal women with and without diabetes

Presenting Author: Kuntikana, A

Background

With increasing longevity of the Indian population, it is now being realized that, as in the West, osteoporotic fractures are a major cause of morbidity and mortality in the elderly. Although reliable epidemiological data are lacking, hospital data suggest that hip fractures are common in India.

Individuals with type 2 diabetes have increased fracture risk despite higher bone mineral density (BMD). Poor glycemic control in type 2 diabetes is associated with fracture risk, high BMD and thicker femoral cortices in narrower bones. Fragility in apparently 'strong" bones in inadequately controlled diabetes can result from microcrack accumulation and/or cortical porosity, reflecting impaired bone repair.

Aim

To evaluate bone mineral density and metabolic bone indices in Asian Indian postmenopausal women with and without diabetes.

Method

We studied clinical and biochemical parameters, serum 25 hydroxy vitamin D(ng/ml) and iPTH(pg/ml) levels and bone mineral density (BMD: DEXA femur neck and total) in 2 groups of postmenopausal women, without history of any known metabolic bone disease: Group A: T2DM [n= 28, mean age= 69 y, diabetes duration 13 y, OHA and / or insulin treated]; Group B: Non DM [n=30; mean age= 69 y].

Results

Compared with Non DM, T2DM subjects had significantly higher serum calcium (p <0.05) and lower phosphorus (<0.01), but similar alkaline phosphatase, 25 hydroxy vitamin D and iPTH levels.

         Number Age Alk Phos Calcium Phosphorus PTH Intact VitD 25OH Corrected Calcium
DM	 28	         69	  84	           9.3	  3.7	        40           	27           	9.5
NON DM 30	70	89          	8.9	          4.2	        40	               24	                9.1
p value			               0.05	        0.009			                                    0.0006
    

Though BMD femur tended to be higher in T2DM, they did not reach statistical significance. [Femur neck BMD and T scores in DM versus Non-DM; R= Right femur; L = Left femur]

              Number  BMD    Right   T Score Right BMD Left  T Score  Left 
DM            28	     0.716	   -2.221	               0.670	     -2.182
NON-DM 30	0.   706	     -2.231	    0.664	             -2.200
p value	              0.473	0.9569	   0.9353         	0.9343
 
On combined analysis (Group A + B; DM and Non-DM), Vitamin D deficiency VDD (25-OH D <10), insufficiency VDI (11-20), and sufficiency VDS (>20) were observed in 7%, 26% and 67% respectively. There was stepwise increase in iPTH between the 3 groups (P < 0.01), reflecting secondary hyperparathyroidism associated with vitamin D deficiency (and insufficiency).

25 OH Vit D Number Age  25 OH Vit D I PTH S Calcium S Phosphorus S Alk Phosphatase
<10                  4	       70	   8	                73	    9.7	         3.8	                 66
11 - 20	        15	       68	15	                42	    9.4	         3.8	                 84
>20	                39	       70	32            	36	   9.2	        4.1	                 90
p value 		                 <0.0001	        0.006		

Discussion

In the groups studied, T2DM subjects had significantly higher serum calcium and lower phosphorus, but similar alkaline phosphatase, 25 hydroxy vitamin D and iPTH levels. T2DM was not associated with significant differences in femur BMD (compared with Non DM). However, hypovitaminosis D and secondary hyperparathyroidism of varying severity were prevalent across both T2DM and Non DM groups.

Few other studies have also reported that serum total calcium levels are higher in individuals with diabetes than in those without. Elevated serum calcium levels have been associated with markers of impaired glucose metabolism and increased risk of diabetes, especially in individuals at high cardiovascular risk.