The Relationship between Bone Mineral Density & Diabetic Women Hanan Hamdy

MD. Rheumatology and Rehabilitation

lengthening of life expectancy of diabetic patients as a result of improvement of medical care allowed for old age diseases including osteoporosis

There are strong evidences that patients with type I diabetes and type II diabetes have an increased risk of osteoporotic fractures.
(Cristiano Zebini, Hospital Heliopolis 2009)

Several mechanisms have been proposed for diabetes-related osteoporosis. These include both the comorbidities of diabetes and more direct pathophysiological effects of the disease itself.
(Sue et al., 2004)

Care of patients with diabetes should include an assessment of bone health. in general type II diabetics has slightly higher BMD as compared to type I diabetics.

(Sue et al., 2004)

Journal of diabetes 2011 a study in brazil shows

Aim of the study

to find out the relationship between osteoporosis and diabetes mellitus in the Egyptian patients. study the degree of bone affection in premenopausal and postmenopausal diabetic females.

Materials & Methods

Study Subjects
Seventy-five female patients were included in the present work. They were from AL-Helal Hospital out patient clinic They were divided into 3 groups.

Group 1
Included 25 post-menopausal diabetic women Their age ranged From 48-70 yrs.

Group 2
Included 25 pre-menopausal diabetic women their age ranged from 38-50 yrs.

Group 3
Included 25 female Non-diabetic patients as a control group.

Inclusion criteria
Postmenopausal diabetics. Premenopausal diabetics. Non diabetic patients at the same age group( as control).

Exclusion criteria
Patients with any other associated factors affecting bone health( diseases other than diabetes, drug intake)

All patients included in the study were subjected to the following:

History of related condition for both diabetes and metabolic bone diseases clinical examination for associated comorbidities of diabetes. blood test to assess glycosylated condition and serum ca & p. DEXA.

The equipment used to measure bone mineral density (BMD) in the present study was the Norland .

Scanning the forearm region

Scanning AP spine

Scanning Hip region

Results

Results of the study showed :

BMD is
lowered in diabetic women than in normal population.

Comparison between control group & postmenopausal diabetic group According to: the DEXA results at hip, wrist & lumber vertebrae
Controls
Mean SD 0.77344 4 0.69153 3

Postmenopausal P value Sign

Mean -1.732 -0.8895 SD 1.27533 7 1.32820 1 <0.05 <0.05 Sig Sig

HIP WRIST SPINE

T+score T+score

0.0028 0.4090 2

T+score

0.1632

0.97234

-1.3529

0.81276

<0.05

Sig

Table shows the comparison between patient in postmenopausal diabetic group & controls as regard DEXA measures

Comparison between control group & premenopausal diabetic group According to: DEXA results at hip, wrist & back spine
Controls
Mean HIP WRIST SPINE
T+score T+score T+score

Pre-menopausal diabetic
P value
Sign

SD

Mean

SD 1.075892 0.801813 1.036683 <0.05 <0.05 <0.05 Sig Sig Sig

0.0028

0.773444 -0.9604

0.40902 0.691533 -0.0728 0.1632 0.97234 -0.6604

Comparison between
postmenopausal diabetic group & Pre-menopausal diabetic group
Premenopausal
T-Score of wrist T-Score of hip

PostControls P-Value menopausal

- 0.7908 + 1.297019 - 1.732 + 1.27533 - 1.3364 + 0.799921
0.40902 0.691533 0.0028 0.773444 0.1632 0.97234 <0.05 Sig. <0.05 Sig. <0.05 Sig.

0.0728 + 0.7351
- 0.9604 + 1.0759

T-Score - 0.6568 + 1.036455 of spine

Table shows Comparison between postmenopausal & pre-menopausal groups regarding DEXA measures

Comparison between DEXA Measure at wrist in the three group

Wrist
30 20 10 0 Normal Postmenopuasal Osteopenia Premenopuasal Osteoporosis control 14 9 3 0 2 0 0 22 25

Comparison between DEXA Measure at Lumber spine in the three group

Back
25 20 15 10 5 0
15

17

15

10

7 2 0 1

Normal

Osteopenia

Osteoporosis

Postmenopuasal

Premenopuasal

Control

Comparison between DEXA Measure at Hip in the three group

Hip
25

15
5 -5

14 12

10 9 11

8 2 2

Normal

Osteopenia

Osteoporosis control

Postmenopuasal

Premenopuasal

DISCUSSION

Bone remolding studies provides evidences that the bone mass is reduced in diabetics. Bone histology studies evidenced that decreased bone formation is one major mechanism leading to reducing bone mass in diabetics.

Journal of pediatrics 2004

The mechanism by which bone loss occurs in diabetic patients:

one of the underling causes is Microangiopathy at the bone tissue.

(Haffner & Bauer, 1993

the other cause which was proved that insulin and insulin like growth factors (IGF-1, IGF-2) have an influence on bone metabolism itself and other growth factors, cytokines and hormones may determine changes in diabetic bone metabolism.
(Leiding Bruck & Zieglr, 2004)

Findings suggest that leptin is involved in the regulation of osteoblast function and bone mass, which is of special interest in diabetes mellitus type II.

( leidig- Brucker 2001)

sustained hyperglycemic state, causes suppression of osteoblast proliferation and its response to parathyroid hormone and 1,25dihydroxyvitamin D.

(Kumeda et al., 1998)

diabetic complication such as neuropathy, nephropathy and myopathy.

Conclusion
Egyptian Postmenopausal diabetic patients have lower BMD measures than non diabetic patients, which mean that diabetes mellitus has an effect on bone formation and bone turn over.

Conclusion
Egyptian Premenopausal diabetic patients have some degree of osteopenia in comparison to premenopausal non diabetic patients .

Recommendations:
Every diabetic female has to measure her bone mineral density and follow up every year to assess her bone mass.

Type I diabetic patients must take vitamin D and Ca++ as part of the medical regimen.

We have to follow up the complication of diabetes mellitus as, peripheral neuropathy, and diabetic retinopathy to decrease the risk of falling.

The regimens having stimulatory effect on bone turnover, such as intermittent PTH therapy and vitamin D, are recommended to treat diabetic osteopenia, besides improvement of diabetic control state.
(Kumeda et al., 1998)

Alendronate reduces the daily consumption of insulin in patients with senile type I diabetes.
(D.Maugeri et al., 2002)