scholarly journals Hemoglobin A1c Threshold for Reduction in Bone Turnover in Men With Type 2 Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Author(s):  
Sabaa Joad ◽  
Elliot Ballato ◽  
FNU Deepika ◽  
Giulia Gregori ◽  
Alcibiades Leonardo Fleires-Gutierrez ◽  
...  

BackgroundEmerging data suggest that type 2 diabetes mellitus (T2D) is associated with an increased risk for fractures despite relatively normal or increased bone mineral density (BMD). Although the mechanism for bone fragility in T2D patients is multifactorial, whether glycemic control is important in generating this impairment in bone metabolism remains unclear. The purpose of our study is to identify a hemoglobin A1c (A1c) threshold level by which reduction in bone turnover begins in men with T2D.MethodA cross-sectional analysis of baseline data was obtained from 217 men, ages 35–65, regardless of the presence or absence of hypogonadism or T2D, who participated in 2 clinical trials. The following data were obtained: A1c by HPLC, testosterone and estradiol by LC/MS, bone turnover markers Osteocalcin [OC], C-terminal telopeptide [CTx], and sclerostin by ELISA, and BMD by DXA. Patients were grouped into 4 categories based of A1c (group I: <6%, group II: 6.0–6.4%, group III: 6.5–6.9%, and group IV: ≥7%). Threshold models were fit to the data using nonlinear regression and group comparisons among the different A1c categories performed by ANOVA.ResultsThreshold model and nonlinear regression showed an A1c cut-off of 7.0, among all choices of A1cs, yields the least sum of squared errors. A comparison of bone turnover markers revealed relatively lower OC (p = 0.002) and CTx (p = 0.0002) in group IV (A1c ≥7%), compared to the other groups. An analysis of men with T2D (n = 94) showed relatively lower OC (p=0.001) and CTx (p=0.002) in those with A1c ≥7% compared to those with <7%, respectively. The significance between groups persisted even after adjusting for medications and duration of diabetes.ConclusionAn analysis across our entire study population showed a breakpoint A1c level of 7% or greater is associated with lower bone turnover. Also in men with T2D, an A1c ≥7% is associated with low bone turnover.

Author(s):  
SwetaVilas Kulkarni ◽  
Suruthi Meenatchi ◽  
R Reeta ◽  
Ramasamy Ramesh ◽  
AR Srinivasan ◽  
...  

2021 ◽  
Vol 10 (10) ◽  
pp. 1337-1343
Author(s):  
Xiaoxia Jia ◽  
Yaxin An ◽  
Yuechao Xu ◽  
Yuxian Yang ◽  
Chang Liu ◽  
...  

Background Obesity is known as a common risk factor for osteoporosis and type 2 diabetes mellitus (T2DM). Perirenal fat, surrounding the kidneys, has been reported to be unique in anatomy and biological functions. This study aimed to explore the relationship between perirenal fat and bone metabolism in patients with T2DM. Methods A total of 234 patients with T2DM were recruited from September 2019 to December 2019 in the cross-sectional study. The biochemical parameters and bone turnover markers (BTMs) were determined in all participants. Perirenal fat thickness (PrFT) was performed by ultrasounds via a duplex Doppler apparatus. Associations between PrFT and bone metabolism index were determined via correlation analysis and regression models. Results The PrFT was significantly correlated with β-C-terminal telopeptides of type I collagen (β-CTX) (r = −0.14, P < 0.036), parathyroid hormone (iPTH) (r = −0.18, P ≤ 0.006), and 25 hydroxyvitamin D (25-OH-D) (r = −0.14, P = 0.001). Multivariate analysis confirmed that the association of PrFT and β-CTX (β = −0.136, P = 0.042) was independent of other variables. Conclusion This study showed a negative and independent association between PrFT and β-CTX in subjects with T2DM, suggesting a possible role of PrFT in bone metabolism. Follow-up studies and further research are necessary to validate the associations and to elucidate the underlying mechanisms.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A276-A276
Author(s):  
Sabaa Salim Joad ◽  
Giulia Gregori ◽  
Vittoria Russo ◽  
Lina E Aguirre ◽  
Georgia Colleluori ◽  
...  

Abstract Background: Emerging data suggest that type 2 diabetes mellitus (T2DM) is associated with increased risk for fractures despite relatively normal or increased bone mineral density (BMD). Furthermore, it is now known that decreased bone turnover mainly due to reduced bone formation is the hallmark for bone disease in T2DM. Whether glucose control is important in generating this impairment in bone metabolism remains unknown and to what extent it would reflect this abnormality is undetermined. The purpose of our study is to identify Hemoglobin A1c (A1c) level threshold by which reduction in bone turnover begins. Method: Baseline data from 217 men between age of 35–65 who were participants in 2 clinical trials conducted at the Michael DeBakey VA Medical Center and the New Mexico VA Health Care System were analyzed. A1c was measured by high performance liquid chromatography, testosterone and estradiol measured by liquid chromatography/mass spectrometry (LC/MS). Bone turnover markers (Osteocalcin [OC],C-telopeptide of type 1 Collagen [CTx]) and sclerostin were measured by enzyme-linked immunosorbent assay. Bone mineral density was assessed by dual energy X-ray absorptiometry. Patients were grouped into 4 categories based of A1c values (%) (group 1:&lt;6, group 2:6.1–6.5, group 3: 6.6–7 and group 4: &gt;7). Simple correlations were assessed by simple regression analysis and group comparisons among the different A1c categories were performed by analysis of variance (ANOVA). Results: The mean age of the participants was 55±9 years old with mean BMI of 36.15±6.44 kg/m2. Participants mean A1c was 6.1±1.5%. Simple correlation analysis showed a significant negative correlation between A1C and OC (r=-0.32, p&lt;0.001) and CTx (r=-0.32, p&lt;0.001). Comparison of bone turn over markers among different A1c groups revealed significantly lower OC in group 4 (A1C&gt;7%), compared to groups with A1Cs ≤7%, i.e. 1, 2 and 3 (4.04 ± 2.64 vs 6.53 ± 3.18, 5.99 ± 3.16 and 6.09 ± 3.16 ng/mL, respectively, p = 0.002). Similarly, CTx was lower in group 4 compared to groups 1, 2, and 3 (0.19 ± 0.12 ng/mL vs 0.34 ± 0.17, 0.32 ± 0.18 and 0.28 ± 0.14 ng/mL, respectively, p=0.0002). Sclerostin levels were comparable among all the A1c categories. Analysis of the subgroup of men with T2DM (n=71) again showed lower OC (3.95 ± 2.68 vs. 6.34 ± 2.77, p=0.007) and CTx (0.18 ± 0.13 vs. 0.31 ± 0.15, p&lt;0.001) in those with A1c &gt;7% compared to those ≤7%, respectively. The significance between the groups persisted even after adjusting for medications, p=0.003. Analysis adjusted for baseline age, weight and testosterone showed no significant difference in areal BMD at all sites in the general population and in the subset of men with T2DM according to A1C categories. Conclusion: Our data analysis showed breakpoint A1c level of 7% or greater is associated with lower bone turnover irrespective of medication use in patients with T2DM.


2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Shehab M Abd El Kader

Background: Type 2 diabetes mellitus (T2DM) is a highly prevalent disease associated with increased the risk of fracture due to altered bone micro architecture and/or poor quality as key factors. Bone remodeling appears to be impaired among patients with T2DM as both markers of bone formation and markers of bone resorption are decreased when compared to healthy subjects. Objective: This study aimed to detect if weight reduction modulates adipokines and markers of bone turnover among T2DM patients. Material and Methods: Eighty obese patients with T2DM (46 men and 34 women), their age ranged from 40-53 years and their body mass index ranged from 30-36 kg/m2 were equally assigned into 2 groups: the weight reduction group received aerobic exercises, diet regimen, where the control group received medical treatment only for 6 months. Results: The mean values of body mass index (BMI), leptin, resistin, visfatin levels significantly decreased, however the mean values of adiponectin, bone alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of type I collagen (NTX) levels significantly increased in the training group. While, the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study. Conclusion: Weight loss ameliorates adipocytokines and bone turnover markers among obese patients with type 2 diabetes mellitus.


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