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Lis M, Niedziela N, Adamczyk-Zostawa J, Wierzbicki K, Czuba Z, Zalejska-Fiolka J, Bartman W, Świętek A, Adamczyk-Sowa M. Can Vitamin D Supplementation Improve Inflammation in Relapsing-Remitting Multiple Sclerosis Patients? Biomedicines 2024; 12:1580. [PMID: 39062153 PMCID: PMC11274703 DOI: 10.3390/biomedicines12071580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Studies indicate that vitamin D (VitD) may reduce inflammation in multiple sclerosis (MS). The aim of the study was to assess the effect of supplementation with different doses of VitD on inflammation in relapsing-remitting MS (RRMS) patients. (2) Methods: The effect of 6-month supplementation with different doses of oral VitD (2000 IU/day) in a high-dose group (HD, n = 23) and a low-dose group (15,960 IU/month) (LD, n = 29) on selected markers of inflammation was assessed in 52 RRMS patients. (3) Results: Females constituted the majority of participants (63.46%). The median age [years] was 39.5 [34.5-49.8] and 47 [40.0-55.0] in the HD and LD groups, respectively. Significant differences were observed in age (p = 0.028), body weight (p = 0.014) and height (p = 0.001) between the study groups. Considering the BMI, statistically significant differences were not found (p = 0.496). The median 25(OH)D concentration [ng/mL] increased from 23.023 [15.578-25.76] in the HD group and 28.318 [20.644-32.232] in the LD group to 29.819 [24.937-38.064] and 30.837 [25.382-36.789], respectively (p < 0.01), and the increase was significantly higher in the HD group (p = 0.01). Hypovitaminosis D was found in most patients (71.2%) initially, and serum VitD levels were still <30.0 ng/mL in 46.2% of the participants at the follow-up. A significant increase in the levels of IL-4, IL-6, IL-17A, IL-22, IL-23 and TNF -α [pg/mL] and a decrease in IL-10 levels were reported during the study (p < 0.01). A significant positive correlation was observed between 25(OH)D serum levels and sCD40L (R = 0.33; p < 0.05) and TNF-α (R = 0.28; p < 0.05), and a significant negative correlation was reported between 25(OH)D and IL-23 (R = -0.32; p < 0.01) at the beginning of the study. (4) Conclusions: In RRMS patients, the doses of VitD were probably too low to induce beneficial effects on inflammation. Further studies are warranted to determine the effect of VitD supplementation on inflammatory markers in MS patients.
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Affiliation(s)
- Martyna Lis
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland (M.A.-S.)
| | - Natalia Niedziela
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland (M.A.-S.)
| | - Jowita Adamczyk-Zostawa
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Krzysztof Wierzbicki
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland (M.A.-S.)
| | - Zenon Czuba
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jolanta Zalejska-Fiolka
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Bartman
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland (M.A.-S.)
| | - Agata Świętek
- Silesia LabMed Research and Implementation Center, Medical University of Silesia in Katowice, 19 Jordana St., 41-808 Zabrze, Poland;
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland (M.A.-S.)
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Chen LY, Ye XH, Cheng JL, Xue Y, Li D, Shao J. The association between vitamin D levels and heart rate variability in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36042638 PMCID: PMC9410659 DOI: 10.1097/md.0000000000030263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To assess the association between serum vitamin D levels and heart rate variability in patients with type 2 diabetes mellitus (T2DM). This study included 469 patients who were retrospective assessed for eligibility from Changzhou Second People's Hospital, Affiliated Nanjing Medical University, between March 2013 and June 2020. A total of 191 T2DM patients were recruited and divided into 3 groups. A total of 191 patients were recruited. A significant difference was noted among groups for HbA1c (P < .001), serum uric acid (P = .048), and urea nitrogen (P = .043). The Vitamin D level in deficiency, insufficiency, and sufficient was 23.17, 38.89, and 63.01 nmol/L, respectively. The insufficient group had lower levels of percentage of normal-to-normal intervals differing by more than 50 milliseconds, and the square root of the mean of the squares of the differences between adjacent normal-to-normal R peak-to-R-peak time intervals than the sufficient vitamin D group. Furthermore, patients in deficiency and insufficiency group were associated with high level of low frequency power/high frequency power as compared with sufficient vitamin D group. Finally, serum 25-hydroxyvitamin D (25(OH)D) levels were positively correlated with rMSSD (P = .002). This study found that low serum 25(OH)D levels were associated with reduced heart rate variability parameters in patients with T2DM.
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Affiliation(s)
- Li Ye Chen
- Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Xin Hua Ye
- Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
- *Correspondence: Xin-Hua Ye, Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou 213000, Jiangsu, China (e-mail: )
| | - Jin Luo Cheng
- Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Yun Xue
- Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - De Li
- Department of Endocrinology, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
| | - Jie Shao
- Department of Electrocardiogram, Changzhou Second People’s Hospital, Affiliated to Nanjing Medical University, Changzhou, China
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Fonseca Santos RK, Santos CB, Reis AR, Brandão-Lima PN, de Carvalho GB, Martini LA, Pires LV. Role of food fortification with vitamin D and calcium in the bone remodeling process in postmenopausal women: a systematic review of randomized controlled trials. Nutr Rev 2021; 80:826-837. [PMID: 34368851 DOI: 10.1093/nutrit/nuab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover. OBJECTIVE To discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women. DATA SOURCES PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as "grey literature". Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used. DATA EXTRACTION Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations. DATA ANALYSIS Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL. CONCLUSIONS The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women. PROSPERO REGISTRATION NUMBER CRD42019131976.
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Affiliation(s)
- Ramara Kadija Fonseca Santos
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Cynthia Batista Santos
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Aline Rocha Reis
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paula Nascimento Brandão-Lima
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Gabrielli Barbosa de Carvalho
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ligia Araújo Martini
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Liliane Viana Pires
- R.K. Fonseca Santos, C.B. Santos, A.R. Reis, G.B. de Carvalho, and L.V. Pires are with the Nutrition Sciences Post-Graduate Program, Department of Nutrition, Federal University of Sergipe, Sergipe, Brazil. P.N. Brandão-Lima is with the Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. L.A. Martini is with the Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil
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Farber PL, Dias A, Freitas T, Pinho AC, Viggiano D, Saldanha C, Silva-Herdade AS. Evaluation of hemorheological parameters as biomarkers of calcium metabolism and insulin resistance in postmenopausal women. Clin Hemorheol Microcirc 2021; 77:395-410. [PMID: 33386795 DOI: 10.3233/ch-200956] [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] [Indexed: 01/22/2023]
Abstract
BACKGROUND Calcium, vitamin D and insulin resistance are linked to osteoporosis and cardiovascular disease in menopause. OBJECTIVE Determine if hemorheological parameters related to blood viscosity in microcirculation are linked to calcium metabolism and insulin resistance in menopause. METHODS 25-Hydroxyvitamin D (25(OH)D)), 1, 25-dihydroxyvitamin D3 (1, 25(OH)2D), parathyroid hormone, ionized calcium, glucose, insulin and hemoglobin A1c were measured in blood from 43 volunteers. Red blood cells (RBC) aggregation, RBC deformability and whole blood viscosity were also performed. RESULTS 25(OH)D showed a positive correlation with RBC deformability 0.60 Pa. Subjects with 25(OH)D≤29.00 ng/mL had lower RBC deformability 0.60 Pa, and higher RBC aggregation and higher HOMA-IR. Ionized calcium showed a negative correlation with RBC aggregation. Subjects with ionized calcium ≤1.24 mmol/L showed higher RBC aggregation. There was a positive correlation between HOMA-IR and RBC aggregation and HOMA-IR showed a negative correlation with RBC deformability 0.30 Pa. Subjects with HOMA-IR <1.80 showed lower RBC aggregation and higher RBC deformability at 0.30 Pa, 0.60 Pa, 1.20 Pa, 3.0 Pa and 6.0 Pa. CONCLUSION Low 25(OH)D, low ionized calcium and high HOMA-IR are related to impaired hemorheology in menopause. RBC aggregation and deformability can be used as biomarkers of calcium metabolism and insulin resistance in menopause.
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Affiliation(s)
| | - Ana Dias
- Hospital da Luz, Aveiro, Portugal
| | - Teresa Freitas
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Diego Viggiano
- ESSUA -Escola Superior de Saúde; Universidade de Aveiro, Aveiro, Portugal
| | | | - Ana S Silva-Herdade
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Mendoza-Garcés L, Velázquez-Alva MC, Cabrer-Rosales MF, Arrieta-Cruz I, Gutiérrez-Juárez R, Irigoyen-Camacho ME. Vitamin D Deficiency is Associated with Handgrip Strength, Nutritional Status and T2DM in Community-Dwelling Older Mexican Women: A Cross-Sectional Study. Nutrients 2021; 13:736. [PMID: 33652581 PMCID: PMC7996586 DOI: 10.3390/nu13030736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the association between handgrip strength, nutritional status and vitamin D deficiency in Mexican community-dwelling older women. A cross sectional study in women ≥ 60 years-old was performed. Plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured by a quantitative immunoassay technique. Handgrip strength was assessed using a dynamometer, while nutritional status was assessed through the Full Mini Nutritional Assessment (Full-MNA). A total of 116 women participated in the study, their mean age was 70.3 ± 5.8 years; 49.1% of the study group had plasma 25(OH)D levels lower than 40 nmol/L [16 ng/mL]. Meanwhile, 28.45% of participants had low handgrip strength (<16 kg), and 23.1% were identified at risk of malnutrition/malnourished according with Full-MNA score. Women with 25(OH)D deficiency (<40 nmol/L [16 ng/mL]) were more likely to have low handgrip strength (OR = 2.64, p = 0.025) compared with those with higher 25(OH)D values. Additionally, being malnourished or at risk of malnutrition (OR = 2.53, p = 0.045) or having type 2 diabetes mellitus (T2DM) (OR = 2.92, p = 0.044) was also associated with low 25(OH)D. The prevalence of low plasma 25(OH)D concentrations was high among Mexican active older women. Low handgrip strength, being at risk of malnutrition/malnourished, or diagnosed with T2DM was also associated with Vitamin D deficiency.
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Affiliation(s)
| | - María Consuelo Velázquez-Alva
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
| | - María Fernanda Cabrer-Rosales
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
| | - Isabel Arrieta-Cruz
- National Institute of Geriatrics, Ministry of Health, Mexico City 10200, Mexico;
| | - Roger Gutiérrez-Juárez
- Department of Biomedical Sciences, School of Medicine, Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City 09230, Mexico;
| | - María Esther Irigoyen-Camacho
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
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Branco JMCR, Smoraog DC, Bentes CM, Netto CC, Marinheiro LPF. Association between vitamin D status and glycemic profile in postmenopausal women with type 2 diabetes. Diabetes Metab Syndr 2019; 13:1685-1688. [PMID: 31235079 DOI: 10.1016/j.dsx.2019.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/21/2019] [Indexed: 01/04/2023]
Abstract
The aim of this study is to evaluate the association between vitamin D status and glycemic profile in postmenopausal women with type 2 diabetes. A cross-sectional study was carried out with 70 (59.47 ± 6.47 years; 1.56 ± 0.05 m; 73.56 ± 13.01 kg; 30.30 ± 5.00 BMI kg/m2) postmenopausal women with type 2 diabetes (T2D). The blood samples were collected after fasting for 12 h and the main outcome parameters were serum follicle-stimulating hormone (FSH), estradiol; 25-OH vitamin D; insulin; C-Reactive Protein; cholesterol total (CT), triglycerides (TG), high density lipoprotein (HDL-cholesterol), glucose; calcium, HDL-cholesterol. The average serum 25(OH)D level in this study was 28.45 ± 8.26 ng/mL. The prevalence of hypovitaminosis D was 60%. Table 1 displays mean and standard deviation values for participants' characteristics. The postmenopause status of the women studied was confirmed by FSH and estradiol measurement. All the clinical and anthropometric characteristics did not show difference (p > 0.05) between the groups (Table 2). Triglycerides level was highest (p < 0.0391) in the hypovitaminosis D group. The other serum markers did not show statistical differences (p > 0.05) between the groups. In conclusion, our results suggest that only TG level shows a negative correlation with vitamin D status in postmenopausal women with type 2 diabetes.
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Affiliation(s)
- Jéssica M C R Branco
- Department of Biochemistry, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Dyego C Smoraog
- Department of Biochemistry, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Claudio Melibeu Bentes
- Oswaldo Cruz Foundation, Fernandes Figueira Institute, Gynecologic and Obstetrics Department, Rio de Janeiro, RJ, Brazil; Academic Coordination of Health at UNISUAM (Centro Universitário Augusto Motta), Rio de Janeiro, RJ, Brazil.
| | - Claudia C Netto
- Department of Biochemistry, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Lizanka P F Marinheiro
- Oswaldo Cruz Foundation, Fernandes Figueira Institute, Gynecologic and Obstetrics Department, Rio de Janeiro, RJ, Brazil
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Rafiq S, Jeppesen PB. Body Mass Index, Vitamin D, and Type 2 Diabetes: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10091182. [PMID: 30154381 PMCID: PMC6164132 DOI: 10.3390/nu10091182] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
The deficiency of vitamin D is prevalent all over the world. Studies have shown that vitamin D may play an important role in the development of obesity. The current study was conducted to quantitatively evaluate the association between serum 25-(OH) vitamin D levels and the risk of obesity in both diabetic and non-diabetic subjects. A systematic review and meta-analysis of observational studies was carried out for that purpose. We searched the Medline, PubMed, and Embase databases throughout all of March 2018. A total of fifty five observational studies for both diabetic and non-diabetic subjects were finally included in the meta-analysis. The data were analyzed by comprehensive meta-analysis software version 3 and the random effects model was used to analyze the data. The meta-analysis showed an overall inverse relationship between serum vitamin D status and body mass index (BMI) in studies of both diabetic (r = −0.173, 95% = −0.241 to −0.103, p = 0.000) and non-diabetic (r = −0.152, 95% = −0.187 to −0.116, p = 0.000) subjects. The evidence of publication bias was not found in this meta-analysis. In conclusion, the deficiency of vitamin D is associated with an increased level of BMI in the studies of both diabetic and non-diabetic subjects. Reliable evidence from well-designed future randomized controlled trials is required to confirm the findings from observational studies and to find out the potential regulatory effects of vitamin D supplementation to lower BMI.
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Affiliation(s)
- Shamaila Rafiq
- Department of Clinical Medicine Aarhus University, 8200 Aarhus, Denmark.
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Abstract
Diabetes mellitus, both type 1 and type 2 (T2DM), is associated with decreased bone strength as well as increased fracture risk. Bone mineral density is decreased in type 1 diabetes but increased in T2DM, compared with controls. This suggests alterations in bone quality are a major player in the pathogenesis of fragility fractures in patients with diabetes. The link between diabetes and bone appears to be mediated by complex pathways, including the insulin-insulin growth factors system, accumulation of advanced glycation end-products in bone collagen, microangiopathy, and increased bone marrow fat content. Bone fragility in T2DM, which is not reflected by bone mineral density and bone mass reduction, depends on deterioration of bone quality. Also, at least in T2DM, the classical diagnosis of osteoporosis by dual-energy X-ray absorptiometry and the fracture risk estimation by FRAX (fracture risk assessment tool) are only partially useful in assessing fracture risk. Trabecular bone score and trabecular bone score-adjusted FRAX offer an enhanced estimation of fracture risk in these patients. Specific risk stratification criteria are needed in the future. The development of improved methods to assess the material properties of bone to better characterize fracture risk is also a priority. Adequate glycemic control is generally associated with decreased fracture risk, with the exception of specific antidiabetics (thiazolidinediones, canagliflozin) that have been shown to have a detrimental effect. Most currently used antiosteoporotic treatments seem equally effective in diabetic patients as compared with patients without diabetes, but clinical data regarding the reduction in fracture risk specifically in patients with diabetes mellitus are lacking.
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Affiliation(s)
- Catalina Poiana
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; C.I.Parhon National Institute of Endocrinology, Bucharest, Romania.
| | - Cristina Capatina
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; C.I.Parhon National Institute of Endocrinology, Bucharest, Romania
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