Metabolic Compensation of Type 2 Diabetes and Bone Quality

Presentation Number: MON 524
Date of Presentation: April 3rd, 2017

Juraj Payer*, Peter Jackuliak, Martin Kuzma and Zdenko Killinger
Comenius University Faculty of Medicine, Bratislava, Slovakia


Introduction: Patients with type 2 diabetes (T2DM) are at an increased risk of osteoporotic fracture despite increased bone mineral density (BMD), which can be caused by compromised bone quality. Poor glycaemic control is associated with higher incidence of all types of fracture risk.

Objective: To determine the role of metabolic compensation measured by glycated haemoglobin (A1c) on BMD and on bone quality measured by trabecular bone score (TBS) in T2DM patients.

Patients and methods: A retrospective cross-sectional trial in 56 women patients with T2DM treated only metformin and DPP-4 inhibitors (drugs with neutral effect on bone metabolism) and 58 healthy controls without diabetes. The diagnosis of diabetes was confirmed according diagnostic criteria of ADA 2011, using the value of fasting plasma glucose and A1c. The BMD at lumbar spine (LS), femoral neck (FN) were measured by dual energy X-ray absorptiometry (DXA, Hologic). TBS Insight® tool was used to assess TBS derived from L-spine DXA scans.

Results: Mean age was similar in both groups (50.3±7.1 vs. 52.2±6.9 yrs, p=0.01). Patients in the study group had greater BMI in comparison to controls (33.1±5.3 kg/m2 vs 28.6±8.1 kg/m2, p=0.04). Duration of diabetes was 5.3±3.8 years. The mean A1c in the study group was 7.6±0.6% DCCT. Diabetes was associated with higher BMD than the control group (1.008±0.175 g/cm2 vs 0.961±0.176 g/cm2, p=0.05). The LS-TBS was lower in T2DM than in control group (1.172±0.120 vs 1.304±0.018, p<0.001). Patients with an cut-off of A1c ≤ 7.4% had significantly higher TBS (1.203±0.089 vs 1.117±0.065, p<0.05), but there was no difference in BMD.

Conclusion: Good glycaemic compensation is an important determinat for BMD as a marker of bone quantity and also TBS, a marker of bone quality. It seems that the cut-off levels of A1c are others for BMD respectivelly TBS. Limitations of our study are that there can be other factors affecting the correlations like duration of diabetes, treatment modalities and other diabetic complications. Reliable A1c cut-offs need to be determined in larger prospective studies.


Nothing to Disclose: JP, PJ, MK, ZK