Bone stiffness in men with type 2 diabetes mellitus

A critical review of diabetes, glycemic control, and dental implant therapy

OBJECTIVES

To systematically examine the evidence guiding the use of implant therapy relative to glycemic control for patients with diabetes and to consider the potential for both implant therapy to support diabetes management and hyperglycemia to compromise implant integration.

MATERIAL AND METHODS

A systematic approach was used to identify and review clinical investigations directly assessing implant survival or failure for patients with diabetes. A MEDLINE (PubMED) database search identified potential articles for inclusion using the search strategy: (dental implants OR oral implants) AND (diabetes OR diabetic). Inclusion in this review required longitudinal assessments including at least 10 patients, with included articles assessed relative to documentation of glycemic status for patients.

RESULTS

Although the initial search identified 129 publications, this was reduced to 16, for inclusion. Reported implant failure rates for diabetic patients ranged from 0% to 14.3%. The identification and reporting of glycemic control was insufficient or lacking in 13 of the 16 studies with 11 of these enrolling only patients deemed as having acceptable glycemic control, limiting interpretation of findings relative to glycemic control. Three of the 16 studies having interpretable information on glycemic control failed to demonstrate a significant relationship between glycemic control and implant failure, with failure rates ranging from 0% to 2.9%.

CONCLUSIONS

Clinical evidence is lacking for the association of glycemic control with implant failure while support is emerging for implant therapy in diabetes patients with appropriate accommodations for delays in implant integration based on glycemic control. The role for implants to improve oral function in diabetes management and the effects of hyperglycemia on implant integration remain to be determined.

Osteoporosis in men with diabetes mellitus

Osteoporosis is more common in women than in men. The prevalence in men is not defined yet; however it is becoming much more recognized as its prevalence and impact have become explicable. It is estimated that around 1% of bone mineral density is lost in men every year. Studies show that secondary osteoporosis is the major cause thus, making it important to define the disorders associated with male osteoporosis. Diabetes is a risk factor for bone fractures. In male patients with diabetes measures should be undertaken such as encouraging exercise, assuring adequate calcium and vitamin D intake, and treating diabetic complications.

Smoking is a strong risk factor for non-vertebral fractures in women with diabetes: the Tromsø Study

In this longitudinal study of 4,160 postmenopausal women (3,947 without and 213 with self-reported diabetes), smoking was strongly related to fracture risk in those with diabetes.

INTRODUCTION

Smoking is related to low bone mass and increased risk of fracture risk in postmenopausal women of the general population. The aim of the present longitudinal population-based study was to examine the effect of smoking on the risk of non-vertebral fractures in women ≥ 55 years of age, with specific focus on its relationship with diabetes.

METHODS

A total of 4,160 women (3,947 without and 213 with self-reported diabetes) from the municipality of Tromsø, Norway, were followed for a mean of 7.6 years. Measurements of height and weight and questionnaire information concerning smoking and alcohol consumption habits, physical activity, prevalent diseases, and use of medication were collected before the start of follow-up. Non-vertebral fractures were registered during follow-up.

RESULTS

A total of 1,015 without and 66 with diabetes sustained a new non-vertebral fracture. Smoking status (never, past, and current) was significantly associated with an increased risk of fracture both in women with and without diabetes (p values for trend 0.02 and <0.001, respectively, after adjustments for age), but in women without diabetes, the relationship was no longer significant after multiple adjustments. There was a strong interaction between smoking status and diabetes on fracture risk (p= 0.004). Women with diabetes who were current smokers had a 3.47 (95% CI 1.82-6.62) higher risk of non-vertebral fractures than diabetic women who were never smokers (p value for linear trend = 0.001, after multiple adjustments).

CONCLUSION

We conclude that smoking is strongly related to fracture risk in postmenopausal women with self-reported diabetes.

Ultrasound bone measurement in an older population with metabolic syndrome

BACKGROUND AND AIMS

Metabolic syndrome and osteoporosis are recognized as major public health problems in many countries. This study investigated the association between bone quality and components of metabolic syndrome in an elderly population.

METHODS

The study included a population sample of 211 men and women, of mean age 77.9 ± 4.5 years. Anthropometry, blood pressure, serum levels of lipoproteins (HDL and LDL), triglycerides and glucose were measured, and ultrasound bone densitometry was performed in all subjects. Information on lifestyle habits, including physical activity, smoking and alcohol consumption, were obtained by a questionnaire.

RESULTS

Metabolic syndrome, defined by the criteria of the International Diabetes Federation, was determined in 59% of men and 65% of women. The quantitative ultrasound index (QUI) was significantly correlated with serum glucose in men (r=-0.31; p=0.005) and with body mass index (BMI) in women (r=0.39; p<0.0001). QUI was significantly lower in men with metabolic syndrome (F=7.57; p<0.007) and significantly higher in women with it (F=6.47; p=0.012) compared with controls. When QUI was adjusted for body mass index in women and for serum glucose in men, it was no longer significantly different from values for controls. Other covariates such as cholesterol, blood pressure, smoking, alcohol, and physical activity did not change the difference in QUI between patients with metabolic syndrome and controls. Diabetes in men (p=0.005) and obesity and waist circumference in women (p<0.05) were also significant predictors of QUI in regression analysis.

CONCLUSIONS

The association between metabolic syndrome and bone stiffness in elderly people may be explained by increased BMI in women and high serum glucose in men.

Bone mass and strength in older men with type 2 diabetes: the Osteoporotic Fractures in Men Study

The effects of type 2 diabetes mellitus (T2DM) on bone volumetric density, bone geometry, and estimates of bone strength are not well established. We used peripheral quantitative computed tomography (pQCT) to compare tibial and radial bone volumetric density (vBMD, mg/cm(3)), total (ToA, mm(2)) and cortical (CoA, mm(2)) bone area and estimates of bone compressive and bending strength in a subset (n = 1171) of men (> or =65 years of age) who participated in the multisite Osteoporotic Fractures in Men (MrOS) study. Analysis of covariance-adjusted bone data for clinic site, age, and limb length (model 1) and further adjusted for body weight (model 2) were used to compare data between participants with (n = 190) and without (n = 981) T2DM. At both the distal tibia and radius, patients with T2DM had greater bone vBMD (+2% to +4%, model 1, p < .05) and a smaller bone area (ToA -1% to -4%, model 2, p < .05). The higher vBMD compensated for lower bone area, resulting in no differences in estimated compressive bone strength at the distal trabecular bone regions. At the mostly cortical bone midshaft sites of the radius and tibia, men with T2DM had lower ToA (-1% to -3%, p < .05), resulting in lower bone bending strength at both sites after adjusting for body weight (-2% to -5%, p < .05) despite the lack of difference in cortical vBMD at these sites. These data demonstrate that older men with T2DM have bone strength that is low relative to body weight at the cortical-rich midshaft of the radius despite no difference in cortical vBMD.