Association of lower serum cholesterol levels with higher risk of osteoporosis in type 2 diabetes

Prevalence of osteoporosis in patients with diabetes mellitus: a systematic review and meta-analysis of observational studies

BACKGROUND

Osteoporosis (OP) and diabetes mellitus (DM) are two major healthcare issues in the world. Numerous population based-studies have reported an increased prevalence of OP among individuals with DM, though, estimates vary significantly.

PURPOSE

The objective of this study is to estimate the prevalence of OP in patients with DM.

METHODS

To identify relevant literature, PubMed, Embase, Medline, CBM and Cochrane Library were searched for studies published from inception till July 2022, The search was conducted, and studies were included without countries and language restrictions. For full-text articles included in the study, the references were also independently searched. Random inverse variance-weighted models were used by Stata version 17.0 to estimate the prevalence of OP in patients with diabetes across studies. The heterogeneity was examined with I² via the χ² test on Cochrane's Q statistic. Subgroup analysis and meta-regression were used to explore potential sources of heterogeneity. Egger's test was used to assess publication bias.

RESULTS

A high OP prevalence of 27.67% (95% confidence interval (CI) 21.37-33.98%) was found in a pooled analysis of 21 studies involving 11,603 T2DM patients. Methodological value of the included articles was high, with only three medium-quality studies and no low-quality studies. A significantly high heterogeneity (I² = 98.5%) was observed.

CONCLUSIONS

Worldwide, a high prevalence of OP was found in patients with T2DM. Therefore, strong measures to prevent and treat osteoporosis in diabetic patients are required.

TRIAL REGISTRATION

This study has been registered on PROSPERO, number CRD42021286580 .

Correlation of Serum Estradiol with Bone Mineral Density and Bone Metabolism in Patients of Postmenopausal Type 2 Diabetes Mellitus Complicated with Osteoporosis

Type 2 diabetes mellitus (T2DM) complicated with osteoporosis, is a systemic metabolic disease that affects postmenopausal women. This disease is closely related to the lack of estrogen. This study aims to demonstrate the correlation between serum estradiol (E2) levels and osteoporosis, bone mineral density, and bone metabolism indicators in postmenopausal women with T2DM complicated with osteoporosis (T2DM-OP). 130 postmenopausal women with T2DM were divided into the T2DM group (n=62) and the T2DM-OP group (n=68) according to bone mineral density (BMD). In addition, 80 postmenopausal women with average blood glucose and bone density were selected as the healthy control group. We compare the serum levels of E2, bone metabolism indicators, and biochemistry indexes among the three groups of participants. Compared with the healthy control and T2DM groups, the BMD and serum level of E2 in T2DM-OP patients were significantly decreased, while the serum levels of bone alkaline phosphatase, type I procollagen amino-terminal propeptide, osteocalcin, and β-collagen C-terminal collagen cross-links were significantly increased. The serum levels of E2 in the postmenopausal T2DM-OP patients are positively correlated with BMD and negatively correlated with bone resorption indicators.

High Body Mass Index and Triglycerides Help Protect against Osteoporosis in Patients with Type 2 Diabetes Mellitus

PURPOSE

This study was conducted to investigate whether high body mass index (BMI) and triglycerides (TGs) were protective factors for reducing osteoporosis (OP) in patients with type 2 diabetes mellitus (T2DM). Participants and Methods. Seventy-nine patients (aged 20 to 81) with T2DM were included in the study. Basic information and blood indicators were collected. Bone mineral density was used to diagnose OP. Participants were grouped according to BMI (normal weight vs. overweight/obese participants), TG (normal TG vs. hypertriglyceridemia), and OP (non-OP vs. OP), and differences were compared between groups. Regression analysis was used to explore whether BMI or TG were independent factors affecting OP.

RESULTS

The proportions of OP in the overweight/obese and hypertriglyceridemic groups were significantly lower than those in the normal weight (30.0% vs. 69.0%; P = 0.001) and normal TG (27.3% vs. 56.5%; P = 0.010) groups. In the OP group, the BMI (24.8 ± 3.4 vs. 26.6 ± 2.5 kg/m2; P = 0.009) was significantly lower than that in the non-OP group, and TG showed the same trend (1.30 (0.81) vs. 1.71 (1.1) mmol/L; P = 0.020). Logistic regression in the crude model showed that the odds ratios (ORs) of OP in the overweight/obese and hypertriglyceridemic groups were 0.193 (95% CI: 0.071, 0.520) and 0.315 (95% CI: 0.119, 0.830) compared with those of the normal weight and normal TG groups. After adjusting for sex and smoking, the ORs were 0.204 (95% CI: 0.074, 0.567) and 0.242 (95% CI: 0.082, 0.709) for the overweight/obese and hypertriglyceridemic groups, respectively. After adjusting for all confounding factors, the ORs for these groups were 0.248 (95% CI: 0.083, 0.746) and 0.299 (95% CI: 0.091, 0.989), respectively.

CONCLUSION

BMI and TG are independent protective factors against OP in patients with T2DM.

Association between the Geriatric Nutritional Risk Index, bone mineral density and osteoporosis in type 2 diabetes patients

AIMS/INTRODUCTION

Low bodyweight and hypoalbuminemia are independently associated with osteoporosis. In this study, the relationship among the Geriatric Nutritional Risk Index (GNRI), bone mineral density (BMD) and osteoporosis in type 2 diabetes mellitus patients was explored, and the GNRI predictive value was evaluated.

MATERIALS AND METHODS

We enrolled 225 men and 192 women with type 2 diabetes mellitus. Their general condition, and laboratory and BMD data were collected. Spearman's partial correlation analysis adjusting for age, body mass index and albumin was used for exploring the association among the GNRI, BMD and bone metabolism markers. Statistical analyses, including multivariate regression analysis and receiver operating characteristic curve analysis, were also applied in this study.

RESULTS

On Spearman's partial correlation analysis, GNRI was positively associated with BMD and albumin-corrected calcium (r = 0.145-0.561, P < 0.01). For the multivariate regression analysis, we observed that the GNRI was dramatically related to high total lumbar, total hip, femur neck BMD and osteoporosis (odds ratio 0.857 for men and 0.927 for women, all P < 0.05). The area under the receiver operating characteristic curve of the GNRI (0.876 for men and 0.704 for women, all P < 0.01) was the largest compared with that of albumin and body mass index in osteoporosis prediction.

CONCLUSIONS

In this study, it was shown that the GNRI was positively correlated with BMD, and inversely correlated with osteoporosis in type 2 diabetes mellitus patients. In addition, compared with body mass index, albumin and age, the GNRI was a more powerful indicator for osteoporosis.

Association Between Bone Mineral Density, Bone Turnover Markers, and Serum Cholesterol Levels in Type 2 Diabetes

Purpose: The association between bone mineral density (BMD), bone turnover markers, and serum cholesterol in healthy population has already been proved. However, in patients with type 2 diabetes mellitus (T2D), it has not been adequately analyzed. In this study, we investigated the correlation between BMD, bone turnover markers, and serum cholesterol levels in people with T2D. Methods: We enrolled 1,040 men and 735 women with T2D from Zhongshan Hospital between October 2009 and January 2013. Their general condition, history of diseases and medication, serum markers, and BMD data were collected. We used logistic regression analysis to identify the association between serum cholesterol levels and BMD as well as bone turnover markers. Results: In multivariate regression analysis, we observed that in men with T2D, high high-density lipoprotein-cholesterol and total cholesterol levels were significantly associated with low total lumbar, femur neck, and total hip BMD, while low-density lipoprotein-cholesterol level was only inversely associated with total lumbar and femur neck BMD. Total cholesterol and low-density lipoprotein-cholesterol levels were also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and β-crosslaps. In women with T2D, high-density lipoprotein-cholesterol level was observed to be negatively correlated with total lumbar, femur neck, and total hip BMD, while total cholesterol and low-density lipoprotein-cholesterol levels were only associated with BMD at the total lumbar. Furthermore, total cholesterol was also negatively associated with osteocalcin, procollagen type I N-terminal propeptide, and β-crosslaps; high-density lipoprotein-cholesterol was only related to osteocalcin and parathyroid hormone, while low-density lipoprotein-cholesterol was only related to β-crosslaps in women. Conclusion: Our study suggests a significantly negative correlation between serum cholesterol levels and BMD in both men and women with T2D. The associations between serum cholesterol levels and bone turnover markers were also observed in T2D patients.

Association between essential hypertension and bone mineral density: a systematic review and meta-analysis

BACKGROUND

We conducted this systematic review and meta-analysis to evaluate the association between essential hypertension (EH) and bone mineral density (BMD).

RESULTS

17 articles were included in our meta-analysis, with a total of 39,491 patients. Of these, 13,375 were patients with EH and 26,116 were patients without EH. Meta-analysis results showed that EH can reduce the BMD of the lumbar spine (95% CI: -0.08∼0.01, P=0.006), femoral neck (95% CI: -0.09∼-0.02, p = 0.001), ward's triangle (95% CI: -0.45∼-0.25, p=0.000), femoral intertrochanteric (95% CI: -0.90∼-0.64, p = 0.000), calcaneus (95% CI: -0.31∼-0.18, p = 0.000) and distal forearm (95% CI: -0.09∼-0.03, p = 0.000), but EH cannot reduce the BMD of the femur rotor (95% CI: -0.07∼0.24, p = 0.273). Subgroup analysis showed that EH can reduce the BMD of the lumbar spine (95% CI: -0.11∼-0.03, p = 0.000) and femoral neck (95% CI: -0.11∼-0.07, p = 0.000) in Asian populations. In non-Asian populations, EH can reduce the BMD of the femoral neck (95% CI: 0.04∼0.19, p = 0.002), but cannot reduce the BMD of the lumbar spine (95% CI: -0.04∼0.11, p = 0.346).

MATERIALS AND METHODS

We conducted a systematic review of the published literature on the association of EH and BMD by searching the Cochrane Library, PubMed, EMBASE, CBM, CNKI and VIP databases inception to October 2016. Stata 11.0 software was used for data analysis.

CONCLUSIONS

Our meta-analysis suggests that EH can reduce the BMD of the human body, and for different parts of the bone, the degree of reduction is different. In addition, for different regions and populations, the reduction level of BMD is inconsistent.

Prevalence of Osteoporosis and Its Associated Factors among Older Men with Type 2 Diabetes

This study investigated the prevalence of osteoporosis and its associated factors in old men with T2DM to identify risk factors for low BMD. We enrolled 93 old men (≥60 years of age) with T2DM and 125 healthy old men (controls) and collected data of their lifestyle, medical history, bone densitometry, body weight, height, and blood pressure. Blood samples were collected for biochemical analyses. Urine samples were collected to determine 24 h urinary creatinine, albumin, and protein. Although no differences in age, blood pressure, waist-to-hip ratio, body mass index (BMI), and testosterone levels were observed, the prevalence of low BMD was significantly higher in the T2DM group compared to the control group. The risk of developing low BMD and fracture in T2DM subjects was increased by 46- and 26-fold, respectively, compared to control subjects. BMD of total spine and hip was positively correlated with BMI and negatively correlated with age, duration of diabetes, creatinine, and 24 h urinary albumin. So old men with T2DM have a greater risk of developing low BMD than old men without T2DM.