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Wang X, Jiang L, Shao X. Association Analysis of Insulin Resistance and Osteoporosis Risk in Chinese Patients with T2DM. Ther Clin Risk Manag 2021; 17:909-916. [PMID: 34511917 PMCID: PMC8418372 DOI: 10.2147/tcrm.s328510] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background To explore the relationship between insulin resistance and osteoporosis risk in Chinese patients with type 2 diabetes mellitus (T2DM). Methods A total of 234 T2DM patients were retrospectively analyzed, and their lumbar bone mineral density (BMD) and insulin resistance using C-peptide-based homeostasis model of insulin resistance [HOMA-IR (CP)] were assessed. Univariate and multivariable logistic regression methods were used to evaluate the association between HOMA-IR (CP) and osteoporosis, and subgroup analysis was performed on female and male patients. Results After fully adjusting the covariates, the association between HOMA-IR (CP) and osteoporosis was only significant in female patients (P = 0.022); the interaction effect with gender was significant (P for interaction <0.05). Curve fitting showed that the relationship between HOMA-IR (CP) and osteoporosis in women was nonlinear. When HOMA-IR (CP) is <4.00, its effect on osteoporosis was not significant (P = 0.474); when HOMA-IR (CP) is >4.00, the risk of osteoporosis increased significantly, with OR = 26.88 (95% CI: 2.75-262.69, P = 0.005). The relationship between insulin resistance and osteoporosis risk in T2DM patients is significantly affected by gender. Conclusion The higher the degree of insulin resistance in female patients, the greater the risk of osteoporosis, but the two are not linearly associated.
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Affiliation(s)
- Xinshui Wang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Lijuan Jiang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
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Mesinovic J, Scott D, Seibel MJ, Cumming RG, Naganathan V, Blyth FM, Le Couteur DG, Waite LM, Handelsman DJ, Hirani V. Risk Factors for Incident Falls and Fractures in Older Men With and Without Type 2 Diabetes Mellitus: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2021; 76:1090-1100. [PMID: 33649759 DOI: 10.1093/gerona/glab062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) increases falls and fracture risk. Our objective was to compare incidence and risk factors for falls and fractures in community-dwelling older men with and without T2DM. METHODS A total of 1705 men (471 with T2DM; 1234 without T2DM) aged ≥70 years were assessed at baseline. Men were contacted every 4 months for 6.0 ± 2.2 years to ascertain incident falls and fractures, with the latter being confirmed by radiographic reports. Hip fractures were ascertained via data linkage (follow-up: 8.8 ± 3.6 years). Risk factors for falls and fractures included physical activity and function, body composition, medications, and vision measures. RESULTS Men with T2DM had similar fall (incident rate ratio [IRR]: 0.92 [95% confidence interval {CI}: 0.70, 1.12], n = 1246) and fracture rates (hazard ratio [HR]: 0.86 [95% CI: 0.56, 1.32], n = 1326) compared to men without T2DM after adjustment for significant risk factors. In men with T2DM, depression (IRR: 1.87 [95% CI: 1.05, 3.34], n = 333), sulphonylurea usage (IRR: 2.07 [95% CI: 1.30, 3.27]) and a greater number of prescription medications (IRR: 1.13 [95% CI: 1.03, 1.24]) were independently associated with increased fall rates, and higher total hip bone mineral density was independently associated with lower fracture rates (HR: 0.63 [95% CI: 0.47, 0.86], n = 351). Interaction terms demonstrated that better contrast sensitivity was independently associated with lower fracture rates (HR: 0.14 [95% CI: 0.02, 0.87]) in men with T2DM compared to men without T2DM. CONCLUSION Fall and fracture rates were similar in men with and without T2DM after adjusting for significant risk factors. Vision assessments including contrast sensitivity measures may improve fracture prediction in older men with T2DM.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia.,Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, Victoria, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, and Department of Endocrinology and Metabolism, Concord Hospital, The University of Sydney, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia.,The Australian Research Council Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia.,ANZAC Research Institute and Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, New South Wales, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing and Alzheimer's Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia.,School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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Campillo-Sánchez F, Usategui-Martín R, Ruiz -de Temiño Á, Gil J, Ruiz-Mambrilla M, Fernández-Gómez JM, Dueñas-Laita A, Pérez-Castrillón JL. Relationship between Insulin Resistance (HOMA-IR), Trabecular Bone Score (TBS), and Three-Dimensional Dual-Energy X-ray Absorptiometry (3D-DXA) in Non-Diabetic Postmenopausal Women. J Clin Med 2020; 9:jcm9061732. [PMID: 32503328 PMCID: PMC7355807 DOI: 10.3390/jcm9061732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/16/2020] [Accepted: 05/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Insulin may play a key role in bone metabolism, where the anabolic effect predominates. This study aims to analyze the relationship between insulin resistance and bone quality using the trabecular bone score (TBS) and three-dimensional dual-energy X-ray absorptiometry (3D-DXA) in non-diabetic postmenopausal women by determining cortical and trabecular compartments. METHODS A cross-sectional study was conducted in non-diabetic postmenopausal women with suspected or diagnosed osteoporosis. The inclusion criteria were no menstruation for more than 12 months and low bone mass or osteoporosis as defined by DXA. Glucose was calculated using a Hitachi 917 auto-analyzer. Insulin was determined using an enzyme-linked immunosorbent assay (EIA). Insulin resistance was estimated using a homeostasis model assessment of insulin resistance (HOMA-IR). DXA, 3D-DXA, and TBS were thus collected. Moreover, we examined bone parameters according to quartile of insulin, hemoglobin A1C (HbA1c), and HOMA-IR. RESULTS In this study, we included 381 postmenopausal women. Women located in quartile 4 (Q4) of HOMA-IR had higher values of volumetric bone mineral density (vBMD) but not TBS. The increase was higher in the trabecular compartment (16.4%) than in the cortical compartment (6.4%). Similar results were obtained for insulin. Analysis of the quartiles by HbA1c showed no differences in densitometry values, however women in Q4 had lower levels of TBS. After adjusting for BMI, statistical significance was maintained for TBS, insulin, HOMA-IR, and HbA1c. CONCLUSIONS In non-diabetic postmenopausal women there was a direct relationship between insulin resistance and vBMD, whose effect is directly related to greater weight. TBS had an inverse relationship with HbA1c, insulin, and insulin resistance unrelated to weight. This might be explained by the formation of advanced glycosylation products (AGEs) in the bone matrix, which reduces bone deformation capacity and resistance, as well as increases fragility.
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Affiliation(s)
| | - Ricardo Usategui-Martín
- IOBA, University of Valladolid, 47011 Valladolid, Spain
- Correspondence: (R.U.-M.); (J.L.P.-C.); Tel./Fax: +34-98-342-3184 (R.U.-M. & J.L.P.-C.)
| | - Ángela Ruiz -de Temiño
- Department Medicine, University of Valladolid, 47005 Valladolid, Spain; (Á.R.-d.T.); (M.R.-M.); (A.D.-L.)
| | - Judith Gil
- Hospital Nuestra Señora de Sonsoles, 05004 Avila, Spain;
| | - Marta Ruiz-Mambrilla
- Department Medicine, University of Valladolid, 47005 Valladolid, Spain; (Á.R.-d.T.); (M.R.-M.); (A.D.-L.)
| | | | - Antonio Dueñas-Laita
- Department Medicine, University of Valladolid, 47005 Valladolid, Spain; (Á.R.-d.T.); (M.R.-M.); (A.D.-L.)
- Department of Medicine, University of Valladolid Service of Clinical Toxicology, Río Hortega University Hospital, 47012 Valladolid, Spain
| | - José Luis Pérez-Castrillón
- Department Medicine, University of Valladolid, 47005 Valladolid, Spain; (Á.R.-d.T.); (M.R.-M.); (A.D.-L.)
- Department of Internal Medicine, Department of Medicine, University of Valladolid, Río Hortega University Hospital, 47012 Valladolid, Spain
- Correspondence: (R.U.-M.); (J.L.P.-C.); Tel./Fax: +34-98-342-3184 (R.U.-M. & J.L.P.-C.)
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