Diabetoporosity – Risk prediction in prediabetic patients based on biochemical and anthropometric biomarkers

Introduction Both type 1 and type 2 diabetes (T1DM, T2DM) not only bear micro- and macrovascular disease risk, but have a substantial effect on bone metabolism and strength. In this study, we investigate the interaction between bone metabolism and densitometry parameters in the context of T2DM, healthy controls and especially prediabetes patients in a large cohort study, the BioPersMed cohort (Biomarkers for personalized Medicine).

Methods To identify putative differences in bone metabolism between healthy (n = 368), pre-diabetic (n = 246) and diabetic patients (n = 138), biochemical and clinical parameters of 752 female (n = 424) and male (n = 328) volunteers were analysed. Bone metabolism markers (e. g. Osteocalcin, P1NP, CTX) and calciotropic hormones such as 25(OH)vitamin D and PTH were associated with DXA-derived data for bone density, trabecular bone score (TBS) and body composition.

Results We were able to confirm the previous findings of “diabetoporosity” in DM patients. Although being older (p < 0,001, No-DM: 56 ± 8, pre-DM: 60 ± 8, DM: 60 ± 9 [y]) DM patients had increased total bone mass (p < 0,001, No-DM: 2578 ± 528, pre-DM: 2657 ± 581, DM: 2839 ± 514 [g]), but decreased TBS (p < 0,001, No-DM: 1.35 ± 0,12, pre-DM: 1,30 ± 0,12, DM: 1,29 ± 0,14 [a.u.]) and impaired bone metabolism, e. g. osteocalcin (OC, p < 0.001, No-DM: 23 ± 7.5, pre-DM: 21 ± 8.5, DM: 17 ± 6.2 [ng/ml]). Of note, decreases in OC (p = 0,004) as well as TBS (p = 0,034) already occurred in prediabetes patients to a lesser extent.

Discussion New imaging technologies, namely trabecular bone score (TBS), but also high resolution peripheral quantitative computed tomography (HRpQCT), and bone turnover markers such as osteocalcin allow for better bone phenotyping of patients with T2DM, already in prediabetes. However, there is an urgent need for further biomarkers as reliable predictive tools for “diabetoporosity”.

Keywords Diabetoporosity, pre-diabetic, prediction

Korrespondenzadresse Christoph Haudum, Medical University of Graz, Division of Endocrinology and Diabetology, Department of Internal Medicine, Stiftingtalstrasse 24, 8010 Graz, Austria,

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