Bone remodeling in patients with type I and type II diabetes mellitus in pre- and postmenopausal periods
Abstract
Aim: to perform structural and functional analysis of the activity of reparative osteogenesis processes at pre- and postmenopausal women with diabetes mellitus (DM).
Materials and Methods. There were enrolled 142 pre- and postmenopausal patients with type I and type II diabetes mellitus type (DM-1 and DM-2) as well as 43 females in control group. Subjects taking medicines acting on bone metabolism comorbid with chronic diseases were excluded from the study. All patients underwent Dual-energy X-ray Absorptiometry (DXA) to assess bone mineral density (BMD, T-score). Serum markers of bone remodeling (alkaline phosphatase, ALP; procollagen type I N propeptide, PINP; beta-Cross laps, b-CTx), metabolic and hormone parameters (glycated hemoglobin, parathyroid hormone, calcitonin, vitamin D, electrolytes) were also measured.
Results. A positive correlation was found between the duration of DM-1 and DM-2 and b-CTx level (DM-1: г = 0.349, р = 0.08; DM-2: г = 0.214, р = 0.04). A negative correlation was found between the lumbar spine T-score and the duration of diabetes (DM-1: r = -0.568, p = 0.001; DM-2: r = -0.267, p = 0.04). A statistically significant correlation was found between the lumbar spine T-score and b-CTx levels (DM-1: r = -0.452, p = 0.002; DM-2: r = -0.357, p = 0.09).
Conclusion. The results of current study suggest that reparative osteogenesis in patients with post-menopausal DM-1 vs. DM-2 and the control group was moderately increased. In patients with DM-2, a less pronounced change in BMD was determined in parallel with inconsistent bone remodeling processes, which casts doubt on the ability of DXA to predict fractures in these patients. Such changes contribute to decreased bone quality, which distinguishes diabetic osteopathy from traditional menopausal osteoporosis manifested mainly by low BMD.
About the Authors
S. S. Safarova
Azerbaijan Medical University
Azerbaijan
Sain S. Safarova - MD, PhD, Associate Professor, Department of Internal Medicine II, Azerbaijan Medical University.
100 Bratyev Mardanovykh Str., Baku AZ 1078.
Azerbaijan
Sain S. Safarova - MD, PhD, Associate Professor, Department of Internal Medicine II, Azerbaijan Medical University.
100 Bratyev Mardanovykh Str., Baku AZ 1078.
S. S. Safarova
Azerbaijan Medical University
Azerbaijan
Saadet S. Safarova - MD, PhD, Associate Professor, Department of Obstetrics and Gynecology I, Azerbaijan Medical University.
100 Bratyev Mardanovykh Str., Baku AZ 1078.
Azerbaijan
Saadet S. Safarova - MD, PhD, Associate Professor, Department of Obstetrics and Gynecology I, Azerbaijan Medical University.
100 Bratyev Mardanovykh Str., Baku AZ 1078.
References
1. Pramojanee S.N., Phimphilai M., Chattipakorn N., Chattipakorn S.C. Possible roles of insulin signaling in osteoblasts. Endocrine Res. 2014;39(4):144-51. https://doi.org/10.3109/07435800.2013.879168.
2. Vestergaard P., Rejnmark L., Mosekilde L. Diabetes and its complications and their relationship with risk of fractures in type 1 and 2 diabetes. Calcif Tissue Int. 2009;84(1):45-55. https://doi.org/10.1007/s00223-008-9195-5.
3. IDF Diabetes Atlas. 9th Edition. International Diabetes Federation, 2019. 176 р. Available at: https://www.diabetesatlas.org/upload/resources/2019/IDF_Atlas_9th_Edition_2019.pdf. [Accessed: 23.04.2020].
4. Farr J.N., Khosla S. Determinants of bone strength and quality in diabetes mellitus in humans. Bone. 2016;82:28-34. https://doi.org/10.1016/j.bone.2015.07.027.
5. Lesnyak O.M., Khoseva E.N. Current approaches to postmenopausal osteoporosis diagnosis and treatment. [Sovremennye podhody k diagnostike i naznacheniyu lecheniya pri postmenopauzal'nom osteoporoze]. Effektivnaya farmakoterapiya. 2013;(38):6-13. (In Russ.).
6. Dedov I.I., Mel'nichenko G.A., Belaia Zh.E., Rozhinskaya L.Ya. Osteoporosis: from a rare symptom of endocrine diseases to the tacit epidemic of XX-XXI centuries. [Osteoporoz - ot redkogo simptoma endokrinnyh boleznej do bezmolvnoj epidemii XX-XXI veka]. Problemy endokrinologii. 2011;57(1):35-45. (In Russ.).
7. Al-Hariri M. Sweet bones: the pathogenesis of bone alteration in diabetes. J Diabetes Res. 2016;2016:6969040. https://doi.org/10.1155/2016/6969040.
8. Menopause medicine. Ed. V.P. Smetnik. [Medicina klimakteriya. Pod red. V.P. Smetnik]. Moskva: Litterra, 2009. 847 s. (In Russ.).
9. Teppeeva T.Kh. Clinical course of the climacteric syndrome of women of Kyrgyzstan. [Klinicheskoe techenie klimakteriya u zhenshchin Kyrgyzstana]. Universum: medicina i farmakologiya. 2016;(7):1. (In Russ.).
10. Clinical guidelines. Osteoporosis. Diagnosis, prevention and therapy. Eds. Prof. O.M. Lesnyak, Prof. L.I. Benevolenskaya. [Klinicheskie rekomendacii. Osteoporoz. Diagnostika, profilaktika i lechenie. Pod red. prof. O.M. Lesnyak, prof. L.I. Benevolenskoj]. Moskva: GEOTAR-Media, 2010. 137 s. (In Russ.). Available at: https://endoinfo.ru/guidelines/rus_osteoporos2009.pdf. [Accessed: 23.04.2020].
11. Benevolenskaya L.I., Toroptsova N.V. Osteoporosis: current diagnostic and treatment options. [Osteoporoz: sovremennye vozmozhnosti diagnostiki i lecheniya]. RMZh. 2010;18(6):389-92. (In Russ.).
12. Assessment of fracture risk and its application to screening for postmenopausal women. Geneva, Switzerland: World Health Organization, 1994. Available at: https://apps.who.int/iris/handle/10665/39142. [Accessed: 23.04.2020].
13. Pobel E.A., Bengus L.M., Dedukh N.V. Markers of bone metabolism in long bone's adhesion. [Markery kostnogo metabolizma pri srashchenii perelomov dlinnyh kostej]. Osteoporoz i osteopatii. 2012;15(2):25-32. (In Russ.).
14. Lesnyak O.M. International research projects in the osteoporosis: common efforts, one goal. [Mezhdunarodnye nauchnye proekty v oblasti osteoporoza: obshchie usiliya, odna cel']. Rossijskij semejnyj vrach. 2016;20(2):43-6. (In Russ.).
15. Safarova S.S. Alterations of bone metabolism in patients with diabetes mellitus. Int J Endocrinol. 2019;2019:5984681. https://doi.org/10.1155/2019/5984681.
16. Starup-Linde J., Vestergaard P. Biochemical bone turnover markers in diabetes mellitus - a systematic review. Bone. 2016;82:69-78. https://doi.org/10.1016/j.bone.2015.02.019.
17. Cunha J.S., Ferreira V.M., Maquigussa E. et al. Effects of high glucose and high insulin concentrations on osteoblast function in vitro. Cell Tissue Res. 2014;358(1):249-56. https://doi.org/10.1007/s00441-014-1913-x.
18. Nikitinskaya O.A., Toroptsova N.V., Demin N.V. Risk factors and bone mineral density in predicting the risk of fracture in postmenopausal women. [Faktory riska i mineral'naya plotnost' kosti v prognozirovanii riska pereloma u zhenshchin v postmenopauze]. Sovremennaya revmatologiya. 2016;10(3):23-8. (In Russ.).
19. Biryukova E.V., Romanova E.V. Postmenopausal osteoporosis: current treatment and prevention of fractures. [Postmenopauzal'nyj osteoporoz: sovremennye vozmozhnosti lecheniya i profilaktiki perelomov]. Effektivnaya farmakoterapiya. 2011;(5):16-20. (In Russ.).
20. Dobrokhotova Yu.E., Dugieva M.Z. Postmenopausal osteoporosis: calcium supplements in current prevention and treatment strategy. [Postmenopauzal'nyj osteoporoz: preparaty kal'ciya v sovremennoj strategii profilaktiki i lecheniya]. RMZh. Mat' i ditya. 2017;25(15):1135-9. (In Russ.).
21. Dymnova S.E., Sergeeva V.V., Rodionova A.Yu. Quality of life and the main aspects of rehabilitation in patients of advanced age with osteoporosis. [Kachestvo zhizni i osnovnye aspekty reabilitacii bol'nyh pozhilogo vozrasta s osteoporozom]. Vestnik sovremennoj klinicheskoj mediciny. 2018;11(6):62-7. (In Russ.).
22. Pigarova EA, Rozhinskaya L.Ya. Current approaches to diagnosis and treatment of osteoporosis. [Sovremennye podhody k diagnostike i lecheniyu osteoporoza]. Consilium Medicum. 2014;16(4):82-7. (In Russ.).
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For citations:
Safarova S.S., Safarova S.S. Bone remodeling in patients with type I and type II diabetes mellitus in pre- and postmenopausal periods. Obstetrics, Gynecology and Reproduction. 2020;14(5):611-618. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.149
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