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Son O. Comparison of the effect of Dapagliflozin and Pioglitazone on the risk of osteoporosis in postmenopausal women with Type-2 diabetes. Pak J Med Sci 2023; 39:1238-1242. [PMID: 37680820 PMCID: PMC10480740 DOI: 10.12669/pjms.39.5.7580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/26/2023] [Accepted: 05/24/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Type 2 Diabetes mellitus (T2DM) and osteoporosis, which increase with age, are two common diseases with different complications. The risk of fractures due to osteoporosis is 2 to 6 times higher in patients with diabetes mellitus (DM). Medications used in the treatment of DM in addition to the disease itself are associated with the risk of osteoporosis and osteoporotic fractures. This study was planned to examine the effects of pioglitazone and dapagliflozin, used in the treatment of T2DM, on the development of osteoporosis in postmenopausal women. Methods This single-centre comparative study was conducted at Endocrine and Metabolic Diseases Polyclinic of a Hospital between April 15, 2019 and April 15, 2020, with a total of 80 postmenopausal female patients with a diagnosis of T2DM and 20 in the control group, aged between 50 and 70. The participants were evaluated under four groups: "Control" without diabetes mellitus (n=20), "Pioglitazone" using (n=30), "Dapagliflozin" using (n=30), and "Other Oral Antidiabetic" using (n=20). Results The mean age of the participants was 61.32±6.27 years. There was no statistically significant difference between the groups in the hip and waist T-score values of participants with T2DM in the study (p>0.05). There was no significant difference in waist and hip t-score values between the intervention groups. Pioglitazone and dapagliflozin used in postmenopausal T2DM patients were determined not to make a significant difference in waist and hip bone mineral density values. Conclusion Our study revealed that pioglitazone and dapagliflozin can be used in postmenopausal T2DM individuals without known osteoporosis and other osteoporosis risk factors.
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Affiliation(s)
- Osman Son
- Osman Son, MD Department of Endocrinology and Metabolic Diseases, Anadolu Hospital, Eskisehir, Turkiye
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Abstract
PURPOSE OF REVIEW Despite estimated 77 million people having diabetes, bone health in Asian Indians with diabetes is largely unknown. This review summarizes the published literature on fracture risk and factors affecting it in Asian Indians with diabetes. RECENT FINDINGS Data on fracture prevalence in diabetes is limited; one study showed that diabetes was associated with a significantly higher number of fractures compared with subjects without diabetes (4% vs. 2.4%, P < 0.05). The prevalence of osteoporosis in Asian Indians with type 2 diabetes mellitus (T2D) varies from 35.5 to 49.5%. Studies have shown an increased, similar or lower areal bone mineral density (BMD) at the lumbar spine and/or hip in patients with T2D compared to controls without diabetes. On the contrary, the BMD in patients with type 1 diabetes mellitus (T1D) is modestly low compared to age- and sex-matched healthy controls without diabetes. Recent studies have shown compromised mechanical, material and compositional properties of trabecular bone in Asian Indians with T2D suggesting deteriorated bone quality as one of the contributors of high fracture risk. SUMMARY Further research is needed to generate evidence-based guidelines to prevent and manage bone fragility in Asian Indians with diabetes.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Correlation between Helicobacter pylori Infection and Metabolic Abnormality in General Population: A Cross-Sectional Study. Gastroenterol Res Pract 2018; 2018:7410801. [PMID: 29743888 PMCID: PMC5883933 DOI: 10.1155/2018/7410801] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Previous studies have suggested a link between Helicobacter pylori (H. pylori) and metabolic abnormality. This study aimed at investigating the correlation between H. pylori infection and metabolic abnormality in a general population. Methods All enrolled participants underwent a carbon-13 urea breath test (13C-UBT). For each individual, the following data were collected: age, gender, alanine transaminase (ALT), total protein, albumin, cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), urea nitrogen, creatinine, uric acid, fasting plasma glucose, postprandial blood sugar, nonalcoholic fatty liver disease (NAFLD), and bone mineral density (BMD). Results The study included 1867 (393 females and 1474 males, aged 54.0 ± 9.6 years) people that took a physical examination. There was no significant difference in gender and age between the study participants with and without H. pylori infection. The statistical data are as follows: albumin: P = 0.045, uric acid: P = 0.025, fasting glucose: P = 0.043, and postprandial blood glucose: P = 0.035. In terms of the patients with NAFLD, there were significant differences in ALT and HDL-C between the study participants with and without H. pylori infection. TG (P = 0.048), HDL-C (P = 0.011), and fasting blood glucose (P = 0.018) were significantly different in both groups among individuals who got osteopenia. Conclusion H. pylori infection may be an important factor affecting metabolic abnormality and osteoporosis.
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Ruppert K, Cauley J, Lian Y, Zgibor JC, Derby C, Solomon DH. The effect of insulin on bone mineral density among women with type 2 diabetes: a SWAN Pharmacoepidemiology study. Osteoporos Int 2018; 29:347-354. [PMID: 29075805 PMCID: PMC5818624 DOI: 10.1007/s00198-017-4276-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/13/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED This was a longitudinal study examining the effects of insulin use on bone mineral density loss. Insulin use was found to be associated with greater bone mineral density loss at the femoral neck among women with diabetes mellitus. INTRODUCTION Women with diabetes mellitus (DM) have higher bone mineral density (BMD) and experience slower BMD loss but have an increased risk of fracture. The data regarding the effect of insulin treatment on BMD remains conflicted. We examined the impact of insulin initiation on BMD. METHODS We investigated the annual changes in BMD associated with the new use of insulin among women with DM in the Study of Women's Health Across the Nation (SWAN). Propensity score (PS) matching, which is a statistical method that helps balance the baseline characteristics of women who did and did not initiate insulin, was used. Covariates with a potential impact on bone health were included in all models. Mixed model regression was used to test the change in BMD between the two groups. Median follow-up time was 5.4 years. RESULTS The cohort consisted of 110 women, mean age, 53.6 years; 49% white and 51% black. Women using insulin (n = 55) were similar on most relevant characteristics to the 55 not using insulin. Median diabetes duration for the user group was 10 vs. 5.0 years for the non-user group. There was a greater loss of BMD at the femoral neck among insulin users (- 1.1%) vs non-users (- 0.77%) (p = 0.04). There were no differences in BMD loss at the spine - 0.30% vs - 0.32% (p = 0.85) or at the total hip - 0.31% vs - 0.25 (p = 0.71), respectively. CONCLUSIONS Women with T2DM who initiated insulin experienced a more rapid BMD loss at the femoral neck as compared to women who did use insulin.
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Affiliation(s)
- K Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA.
| | - J Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA
| | - Y Lian
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 4420 Bayard St Suite 600, Pittsburgh, PA, 15260, USA
| | - J C Zgibor
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - C Derby
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - D H Solomon
- Division of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Sharma B, Singh H, Chodhary P, Saran S, Mathur SK. Osteoporosis in Otherwise Healthy Patients with Type 2 Diabetes: A Prospective Gender Based Comparative Study. Indian J Endocrinol Metab 2017; 21:535-539. [PMID: 28670536 PMCID: PMC5477440 DOI: 10.4103/ijem.ijem_108_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes mellitus (T2DM) may affect bone loss differentially in adult males and postmenopausal females. We evaluated the prevalence of osteoporosis in otherwise healthy adults with T2DM. MATERIALS AND METHODS In a cross-sectional study, adults with T2DM, aged 50 years and above, were evaluated for bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scan at spine and hip. T-score of ≤-2.5 was defined as osteoporosis and score -2.49 to -1.0 as osteopenia at either site. Correlation of low BMD with demographic, clinical, and laboratory parameters including serum Vitamin D and serum testosterone (in males) was evaluated. RESULTS In 200 patients, mean age was 64.5 ± 7.0 years and age differed significantly in males and females (P < 0.0001). Osteoporosis was present in 35.5% adults with T2DM. Significantly greater proportion of females had osteoporosis (49.5% vs. 22.3%, P < 0.0001). Frequency of osteoporosis at spine (33.5%) was higher than the same at hip (13.5%). Compared to males, significantly greater proportion of females had osteoporosis and osteopenia at both spine (P < 0.0001) and hip (P < 0.0001). Among all parameters assessed, a significant positive correlation of T-score at spine and hip was seen with body mass index in both males (r = 0.287, P = 0.003 at spine and r = 0.421, P < 0.0001 at hip) and females (r = 0.291, P = 0.004 at spine and r = 0.280, P = 0.010 at hip). There was no association of Vitamin D deficiency (45.5% patients) with either T-score and presence of osteoporosis either at spine (P = 0.388 and P = 0.177) or hip (P = 0.431 and P = 0.593). CONCLUSION Prevalence of osteoporosis in otherwise healthy T2DM was 35.5% with greater prevalence in females than males. Body mass but not Vitamin D or testosterone has an important role in the determination of bone loss in T2DM.
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Affiliation(s)
- Balram Sharma
- Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India
| | - Hema Singh
- Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India
| | - Praveen Chodhary
- Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India
| | - Sanjay Saran
- Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India
| | - Sandeep Kumar Mathur
- Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India
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Al-Homood IA, Sheshah I, Mohammed AGA, Gasim GI. The Prevalence and Risk Factors of Osteoporosis among a Saudi Female Diabetic Population. Open Access Maced J Med Sci 2017; 5:177-181. [PMID: 28507624 PMCID: PMC5420770 DOI: 10.3889/oamjms.2017.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 02/02/2023] Open
Abstract
AIM: This study aimed to assess the prevalence and determinants of osteoporosis [lumbar spine (LS) and femoral neck (FN)] among patients with type 2 diabetes at King Salman Hospital. MATERIALS AND METHODS: One hundred seventy patients with type 2 diabetes were enrolled in this cross-sectional study in the period from the 1st of January until the 1st of July 2015. Patient selection was based on self-report of the previous diagnosis by a physician, being on an antidiabetic agent, or a fasting glucose of 126 mg/dl as per the American Diabetes Association criteria. A dual energy X-ray absorptiometry scan with the bone mineral density (BMD) categorization based on the WHO cut of levels of T-scores and determination of vitamin D levels were performed. A detailed questionnaire was used to collect demographic data. RESULTS: Out of 170 participants, 50 (29.4%) were diagnosed as having osteoporosis, while 68 (40%) were diagnosed with osteopenia. Age was determined as a risk factor for a decreased BMD in patients with osteopenia (odds ratio (OR) = 1.1, 95% confidence interval (CI) = (1.0-1.1), p = 0.039) and osteoporosis (OR = 1.1, CI = 1.0-1.2, p < 0.001). Similarly, oral hypoglycemic agents (OHA) increased the risk of decreased BMD in osteopenia (OR = 2.6; CI = 1.0-6.7; p = 0.023) as well as osteoporosis, (OR = 3.8; CI = 1.3-10.9; p = 0.013), while vitamin D deficiency increased the risk of osteopenia OR = 3.0; CI = 1.2-7.2; p = 0.012). Increased BMI decreased the risk of both osteopenia and osteoporosis (OR = 0.9; CI = 0.9-0.99; p = 0.031 vs. OR = 0.9; CI = 0.80-0.95; p = 0.003). CONCLUSION: Advanced age, OHA and vitamin D deficiency are determinants of decreased BMD in Saudi women with type 2 diabetes, while an increased BMI protects against low BMD.
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Affiliation(s)
| | - Iman Sheshah
- Diabetic Center, King Salman Hospital, Riyadh, Saudi Arabia
| | - Abdel Gaffar A Mohammed
- Medical Specialties Department, Rheumatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gasim I Gasim
- Alneelain University, Faculty of Medicine and Health Sciences, Khartoum, Sudan
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Kulkarni SV, Meenatchi S, Reeta R, Ramesh R, Srinivasan AR, Lenin C. Association of Glycemic Status with Bone Turnover Markers in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2017; 7:247-251. [PMID: 29308363 PMCID: PMC5752810 DOI: 10.4103/ijabmr.ijabmr_35_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context Type 2 diabetes mellitus has profound implications on the skeleton. Even though bone mineral density is increased in type 2 diabetes mellitus patients, they are more prone for fractures. The weakening of bone tissue in type 2 diabetes mellitus can be due to uncontrolled blood sugar levels leading to high levels of bone turnover markers in blood. Aims The aim of this study is to find the association between glycemic status and bone turnover markers in type 2 diabetes mellitus. Settings and Design This case-control study was carried out in a tertiary health care hospital. Subjects and Methods Fifty clinically diagnosed type 2 diabetes mellitus patients in the age group between 30 and 50 years were included as cases. Fifty age- and gender-matched healthy nondiabetics were included as controls. Patients with complications and chronic illness were excluded from the study. Depending on glycated hemoglobin (HbA1c) levels, patients were grouped into uncontrolled (HbA1c >7%, n = 36) and controlled (HbA1c <7%, n = 14) diabetics. Based on duration of diabetes, patients were grouped into newly diagnosed, 1-2 years, 3-5 years, and >5 years. Serum osteocalcin (OC), bone alkaline phosphatase (BAP), acid phosphatase (ACP), and HbA1c levels were estimated. OC/BAP and OC/ACP ratio was calculated. Statistical Analysis Used Student's t-test, analysis of variance, and Chi-square tests were used for analysis. Receiver operating characteristic (ROC) curve analysis was done for OC/BAP and OC/ACP ratios. Results Serum OC, HbA1c, and OC/BAP ratio were increased in cases when compared to controls and were statistically significant (P < 0.001). OC/ACP ratio was decreased in type 2 diabetes mellitus and was statistically significant (P = 0.01). In patients with >5-year duration of diabetes, HbA1c level was high and was statistically significant (P < 0.042). BAP levels were high in uncontrolled diabetics but statistically not significant. ROC curve showed OC/BAP ratio better marker than OC/ACP ratio. Conclusions Uncontrolled type 2 diabetes mellitus affects bone tissue resulting in variations in bone turnover markers. Bone turnover markers are better in predicting recent changes in bone morphology and are cost effective.
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Affiliation(s)
- Sweta Vilas Kulkarni
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Suruthi Meenatchi
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - R Reeta
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Ramasamy Ramesh
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - A R Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - C Lenin
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Mahajan A. Selection bias: Selection of controls as a critical issue in the interpretation of results in a case control study. Indian J Med Res 2016; 142:768. [PMID: 26831427 PMCID: PMC4774075 DOI: 10.4103/0971-5916.174574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anjali Mahajan
- Department of Community Medicine, Indira Gandhi Medical College, Shimla 171 001, Himachal Pradesh, India
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Affiliation(s)
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College & Hospital, Vellore 632 004, Tamil Nadu, India
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Kumar B, Ravisankar A, Mohan A, Kumar D, Katyarmal D, Sachan A, Sarma K. Authors' response. Indian J Med Res 2015; 142:769. [PMID: 26831428 PMCID: PMC4774076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- B.S. Kumar
- Division of Rheumatology, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - A. Ravisankar
- Division of Rheumatology, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - A. Mohan
- Division of Rheumatology, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - D.P. Kumar
- Division of Rheumatology, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - D.T. Katyarmal
- Division of Rheumatology, Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - A. Sachan
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517 507, Andhra Pradesh, India
| | - K.V.S. Sarma
- Department of Statistics, Sri Venkateswara University, Tirupati 517 507, Andhra Pradesh, India
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