Associations of Bone Mineral Density and Bone Metabolism Indices with Urine Albumin to Creatinine Ratio in Chinese Patients with Type 2 Diabetes

Abstract

Objective To identify correlations of bone mineral density (BMD) and bone metabolism indices with the urine albumin to creatinine ratio (ACR) as an indicator of nephropathy in Chinese patients with type 2 diabetes (T2D).

Methods In this retrospective analysis, 297 patients with T2D were divided into 3 groups according to the urine ACR. Patients’ data were analyzed to identify associations of general conditions, blood glucose level, lipid levels, and uric acid level with BMD and bone metabolism indices.

Results BMD at every location tested (femoral neck, trochanter, inside hip, Ward’s triangle, total hip, and lumbar vertebrae) was negatively correlated with the urine ACR (all p<0.05). Osteocalcin, beta-C-terminal telopeptide (β-CTX), and procollagen type 1 N- peptide (P1NP) were positively correlated with urine ACR (all p<0.05). Finally, 25-hydroxyvitamin D [25(OH)D] was negatively correlated with urine ACR (p<0.05). Multiple regression analysis with adjustment for age, body mass index, disease duration, and other clinical measurements revealed no significant correlation between urine ACR and BMD measurements or β-CTX (p>0.05). However, significant correlations remained between urine ACR and osteocalcin, P1NP, and 25(OH)D (p<0.05). The same results were obtained for postmenopausal women specifically, with the exception of a significant correlation between the ACR and β-CTX (p<0.05).

Conclusion In the early stage of diabetic nephropathy, BMD changes and bone transformation acceleration may occur, and the acceleration of bone transformation may occur before the change in BMD. Therefore, it is important to monitor bone metabolism indices in the early stage of diabetic nephropathy in T2D patients.

Key words

type 2 diabetes mellitus - osteoporosis - BMD - ACR

• References

• 1 Paschou SA, Dede AD, Anagnostis PG. et al. Type 2 Diabetes and Osteoporosis: A Guide to Optimal Management. J Clin Endocrinol Metab 2017; 102: 3621-3634
• 2 World Health Organization. Global report on diabetes. 2016. ISBN: 978 924 1565257
• 3 Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes. Int J Endocrinol 2014; 2014: 820615
• 4 Liao CC, Lin CS, Shih CC. et al. Increased risk of fracture and postfracture adverse events in patients with diabetes: Two nationwide population-based retrospective cohort studies. Diabetes Care 2014; 37: 2246-2252
• 5 Oei L, Rivadeneira F, Zillikens MC. et al. Diabetes, diabetic complications, and fracture risk. Curr Osteoporos Rep 2015; 13: 106-115
• 6 Hu F, Jiang C, Shen J. et al. Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Injury 2012; 43: 676-685
• 7 Ekstrom W, Al-Ani AN, Saaf M. et al. Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture – a 2 year follow-up study. Injury 2013; 44: 769-775
• 8 Sanches CP, Vianna AGD, Barreto FC. The impact of type 2 diabetes on bone metabolism. Diabetol Metab Syndr 2017; 9: 85
• 9 Kazama JJ, Matsuo K, Iwasaki Y. et al. Chronic kidney disease and bone metabolism. J Bone Miner Metab 2015; 33: 245-252
• 10 Molitch ME, DeFronzo RA, Franz MJ. et al. Diabetic nephropathy. Diabetes Care 2003; 26 (Suppl. 01) S94-S98
• 11 Walsh JS, Vilaca T. Obesity, Type 2 Diabetes and Bone in Adults. Calcif Tissue Int 2017; 100: 528-535
• 12 Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes – a meta-analysis. Osteoporos Int 2007; 18: 427-444
• 13 Oei L, Zillikens MC, Dehghan A. et al. High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: The Rotterdam Study. Diabetes Care 2013; 36: 1619-1628
• 14 Zhang W, Shen X, Wan C. et al. Effects of insulin and insulin-like growth factor 1 on osteoblast proliferation and differentiation: Differential signalling via Akt and ERK. Cell Biochem Funct 2012; 30: 297-302
• 15 Strollo R, Rizzo P, Spoletini M. et al. HLA-dependent autoantibodies against post-translationally modified collagen type II in type 1 diabetes mellitus. Diabetologia 2013; 56: 563-572
• 16 Wongdee K, Charoenphandhu N. Update on type 2 diabetes-related osteoporosis. World J Diabetes 2015; 6: 673-678
• 17 Moayeri A, Mohamadpour M, Mousavi SF. et al. Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: A systematic review and meta-analysis. Ther Clin Risk Manag 2017; 13: 455-468
• 18 Epstein S, Defeudis G, Manfrini S. et al. Diabetes and disordered bone metabolism (diabetic osteodystrophy): Time for recognition. Osteoporos Int 2016; 27: 1931-1951
• 19 Huebschmann AG, Regensteiner JG, Vlassara H. et al. Diabetes and advanced glycoxidation end products. Diabetes Care 2006; 29: 1420-1432
• 20 Oikawa A, Siragusa M, Quaini F. et al. Diabetes mellitus induces bone marrow microangiopathy. Arterioscler Thromb Vasc Biol 2010; 30: 498-508
• 21 Yamada S, Inaba M. Diabetes mellitus and osteoporosis. Bone metabolic disorder in diabetic nephropathy. Clin Calcium 2012; 22: 1333-1341
• 22 Chaiban JT, Nicolas KG. Diabetes and bone: Still a lot to learn. Clin Rev. Bone Miner Metab 2015; 13: 20-35
• 23 Kostoglou-Athanassiou I, Athanassiou P, Gkountouvas A. et al. Vitamin D and glycemic control in diabetes mellitus type 2. Ther Adv Endocrinol Metab 2013; 4: 122-128
• 24 Mitri J, Muraru MD, Pittas AG. Vitamin D and type 2 diabetes: A systematic review. Eur J Clin Nutr 2011; 65: 1005-1015