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Spinal deformity index in patients with type 2 diabetes

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An Erratum to this article was published on 19 January 2013

Abstract

The objective of this study is to investigate bone metabolism, density, and quality in patients with diabetes type 2 using DEXA and spinal deformity index (SDI), a surrogate index of bone quality. Fifty-six patients with type 2 diabetes were studied; exclusion criteria were diseases and medications that affect bone and mineral metabolism. Mean age was 65 ± 7 years. Mean diabetes duration was 10 ± 7 years and mean HbA1C was 6.6 ± 0.5 %. BMI was 30 ± 4. Fifty-six sex, age, and BMI matched served as controls. All subjects underwent a clinical and biochemical examination. Spinal and femoral neck BMD were measured by DEXA, and a spine radiography was performed to assess vertebral fractures and to calculate SDI. Mean serum 25-OH vitamin D levels were 19.6 ± 3.7 ng/ml in patients and 30 ± 14 ng/ml in controls (p < 0.01). PTH serum levels were 47.9 ± 40 pg/ml in patients versus 37 ± 5.3 pg/ml in controls (p < 0.01). At lumbar spine there was a significant difference between patients and controls only for T-score (p = <0.01), while at femoral neck there was a difference in BMD (p < 0.01) and in T-score (p < 0.01). Radiological vertebral fractures were found in 46 % of patients and 17 % of controls (p < 0.05). SDI was higher in patients than in controls (p < 0.05). The percentage of fractures with T-score BMD greater than −2.5 was 69 % in patients and 10 % in controls (p < 0.05). As a conclusion, BMD was similar in patients and in controls, while SDI value was higher in patients; therefore, SDI was more specific than BMD for the diagnosis of osteoporosis due to metabolic diseases.

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References

  1. K.K. Nicodemus, A.R. Folsom, Iowa Women’s Health Study: type 1 and 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24, 1192–1197 (2001)

    Article  PubMed  CAS  Google Scholar 

  2. G.C. Isaia, P. Ardissone, M. Di Stefano, D. Ferrari, V. Martina, M. Porta, M. Tagliabue, G.M. Molinatti, Bone metabolism in type 2 diabetes mellitus. Acta Diabetol. 36, 35–38 (1999)

    Article  PubMed  CAS  Google Scholar 

  3. R.Q. Ivers, R.G. Cumming, P. Mitchell, A.J. Peduto, Blue Mountains Eye Study.: diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care 24, 1198–1203 (2001)

    Article  PubMed  CAS  Google Scholar 

  4. P. McNair, S. Madsbad, M.S. Christensen, C. Christiansen, O.K. Faber, C. Binder, I. Transbøl, Bone mineral loss in insulin-treated diabetes mellitus: studies on pathogenesis. Acta Endocrinol. 90, 463–472 (1979)

    PubMed  CAS  Google Scholar 

  5. G. Hein, R. Wiegand, G. Lehmann, G. Stein, S. Franke, Advanced glycation end-products pentosidine and N epsilon-carboxymethyllysine are elevated in serum of patients with osteoporosis. Rheumatology (Oxford) 42, 1242–1246 (2003)

    Article  CAS  Google Scholar 

  6. G. Hein, R. Wiegand, G. Lehmann, G. Stein, S. Franke, Advanced glycation end product modification of bone proteins and bone remodelling: hypothesis and preliminary immunohistochemical findings. Ann. Rheum. Dis. 65, 101–104 (2006)

    Article  PubMed  CAS  Google Scholar 

  7. P. Odetti, S. Rossi, F. Monacelli, A. Poggi, M. Cirnigliaro, M. Federici, A. Federici, Advanced glycation end products and bone loss during aging. Ann. N. Y. Acad. Sci. 1043, 710–717 (2005)

    Article  PubMed  CAS  Google Scholar 

  8. M. Saito, K. Fujii, S. Soshi, T. Tanaka, Reductions in degree of mineralization and enzymatic collagen cross-links and increases in glycation-induced pentosidine in the femoral neck cortex in cases of femoral neck fracture. Osteoporos. Int. 17(7), 986–995 (2006)

    Article  PubMed  CAS  Google Scholar 

  9. S. Yamagishi, K. Nakamura, H. Inoue, Possible participation of advanced glycation end products in the pathogenesis of osteoporosis in diabetic patients. Med. Hypotheses 65, 1013–1015 (2005)

    Article  PubMed  CAS  Google Scholar 

  10. M. Rix, H. Andreassen, P. Eskildsen, Impact of peripheral neuropathy on bone density in patients with type 1 diabetes. Diabetes Care 22, 827–831 (1999)

    Article  PubMed  CAS  Google Scholar 

  11. D. Hadjidakis, Bone mineral density in type II diabetics with macroangiopathy. J. Bone Miner. Res. 12(Suppl 1), S516 (1997)

    Google Scholar 

  12. M.S. Maurer, J. Burcham, H. Cheng, Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J. Gerontol. A. Biol. Sci. Med. Sci. 60, 1157–1162 (2005)

    Article  PubMed  Google Scholar 

  13. J.P. Williams, H.C. Blair, J.M. McDonald, M.A. McKenna, S.E. Jordan, J. Williford, R.W. Hardy, Regulation of osteoclastic bone resorption by glucose. Biochem. Biophys. Res. Commun. 235, 646e51 (1997)

    Article  Google Scholar 

  14. D. Vashishth, G.J. Gibson, J.I. Khoury, M.B. Schaffler, J. Kimura, D.P. Fyhrie, Influence of nonenzymatic glycation on biomechanical properties of cortical bone. Bone 28, 195–201 (2001)

    Article  PubMed  CAS  Google Scholar 

  15. M. Saito, K. Marumo, Collagen cross-links as a determinant of bone quality: a possible explanation for bone fragility in aging, osteoporosis, and diabetes mellitus. Osteoporos. Int. 21, 195–214 (2010)

    Article  PubMed  CAS  Google Scholar 

  16. S. Viguet-Carrin, J.P. Roux, M.E. Arlot, Z. Merabet, D.J. Leeming, I. Byrjalsen, P.D. Delmas, M.L. Bouxsein, Contribution of the advanced glycation end product pentosidine and of maturation of type I collagen to compressive biomechanical properties of human lumbar vertebrae. Bone 39, 1073–1079 (2006)

    Article  PubMed  CAS  Google Scholar 

  17. P. Vestergaard, Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes–a meta-analysis. Osteoporos. Int. 18, 427–444 (2007)

    Article  PubMed  CAS  Google Scholar 

  18. J.F. Griffith, H.K. Genant, New advances in imaging osteoporosis and its complications. Endocrine 42(1), 39–51 (2012)

    Article  PubMed  CAS  Google Scholar 

  19. G.G. Crans, H.K. Genant, J.H. Krege, Prognostic utility of a semiquantitative spinal deformity index. Bone 37, 175–179 (2005)

    Article  PubMed  Google Scholar 

  20. H.K. Genant, P.D. Delmas, P. Chen, Y. Jiang, E.F. Eriksen, G.P. Dalsky, R. Marcus, J. San Martin, Severity of vertebral fracture reflects deterioration of bone microarchitecture. Osteoporos. Int. 18, 69–76 (2007)

    Article  PubMed  CAS  Google Scholar 

  21. Expert Committee on the Diagnosis and Classification of diabetes mellitus, Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(suppl 1), S5–S20 (2003)

    Google Scholar 

  22. C. Tsigos, V. Hainer, A. Basdevant, N. Finer, M. Fried, E. Mathus-Vliegen, D. Micic, M. Maislos, G. Roman, Y. Schutz, H. Toplak, B. Zahorska-Markiewicz, Obesity management task force of the European Association for the study of obesity. Management of obesity in adults: European clinical practice guidelines. Obes. Facts 1(2), 106–116 (2008)

    Article  PubMed  Google Scholar 

  23. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive summary of third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285, 2486–2497 (2001)

    Article  Google Scholar 

  24. M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney, M.H. Murad, C.M. Weaver, Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(7), 1911–1930 (2011)

    Article  PubMed  CAS  Google Scholar 

  25. World Health Organization, Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ. Tech. Rep. Ser. 843, 1–129 (1994)

    Google Scholar 

  26. Y. Fukunaga, Does insulin use increase bone mineral density in patients with non-insulin-dependent diabetes mellitus? Arch. Intern. Med. 157, 2668–2669 (1997)

    Article  PubMed  CAS  Google Scholar 

  27. E. Barret-Connor, D. Kritz-Silverstein, Does Hyperinsulinemia preserve bone? Diabetes Care 19, 1388–1392 (1996)

    Article  Google Scholar 

  28. L. Forsen, H.E. Meyer, K. Midthjell, T.H. Edna, Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 42, 920–925 (1999)

    Article  PubMed  CAS  Google Scholar 

  29. E. Canalis, G. Mazziotti, A. Giustina, J.P. Bilezikian, Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos. Int. 18(10), 1319–1328 (2007)

    Article  PubMed  CAS  Google Scholar 

  30. G. Mazziotti, A. Bianchi, S. Bonadonna, M. Nuzzo, V. Cimino, A. Fusco, L. De Marinis, A. Giustina, Increased prevalence of radiological spinal deformities in adult patients with GH deficiency: influence of GH replacement therapy. J. Bone Miner. Res. 21(4), 520–528 (2006)

    Article  PubMed  CAS  Google Scholar 

  31. G. Mazziotti, A. Bianchi, S. Bonadonna, V. Cimino, I. Patelli, A. Fusco, A. Pontecorvi, L. De Marinis, A. Giustina, Prevalence of Vertebral Fractures in Men with Acromegaly. J. Clin. Endocrinol. Metab. 93, 4649–4655 (2008)

    Article  PubMed  CAS  Google Scholar 

  32. C. Torti, G. Mazziotti, P.A. Soldini, E. Focà, R. Maroldi, D. Gotti, G. Carosi, A. Giustina, High prevalence of radiological vertebral fractures in HIV-infected males. Endocrine 41(3), 512–517 (2012)

    Article  PubMed  CAS  Google Scholar 

  33. C. Gazzaruso, An increased risk for fractures: another cause of frailty in HIV-infected subjects. Endocrine 41(3), 347–349 (2012)

    Article  PubMed  CAS  Google Scholar 

  34. A.V. Schwartz, D.E. Sellmeyer, K.E. Ensrud, J.A. Cauley, H.K. Tabor, P.J. Schreiner, S.A. Jamal, D.M. Black, S.R. Cummings, Study of Osteoporotic Features Research Group. Older women with diabetes have an increased risk of fracture: a prospective study. J. Clin. Endocrinol. Metab. 86, 32–38 (2001)

    Article  PubMed  CAS  Google Scholar 

  35. T. Mancini, G. Mazziotti, M. Doga, R. Carpinteri, N. Simetovic, P.P. Vescovi, A. Giustina, Vertebral fractures in males with type 2 diabetes treated with rosiglitazone. Bone 45(4), 784–788 (2009)

    Article  PubMed  CAS  Google Scholar 

  36. D.E. Bonds, J.C. Larson, A.V. Schwartz, E.S. Strotmeyer, J. Robbins, B.L. Rodriguez, K.C. Johnson, K.L. Margolis, Risk of fracture in women with type 2 diabetes: the Women’s Health Initiative Observational Study. J. Clin. Endocrinol. Metab. 91, 3404–3410 (2006)

    Article  PubMed  CAS  Google Scholar 

  37. I.I. de Liefde, M. van der Klift, C.E. de Laet, P.L. van Daele, A. Hofman, H.A. Pols, Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos. Int. 16, 1713–1720 (2005)

    Article  PubMed  Google Scholar 

  38. D.M. Black, N.K. Arden, L. Palermo, J. Pearson, S.R. Cummings, Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J. Bone Miner. Res. 14, 821–828 (1999)

    Article  PubMed  CAS  Google Scholar 

  39. NIH Consensus Development Panel Osteoporosis prevention diagnosis and therapy, Osteoporosis prevention, diagnosis, and therapy. JAMA 285, 785–795 (2001)

    Article  Google Scholar 

  40. I. Chiodini, V. Morelli, B. Masserini, A.S. Salcuni, C. Eller-Vainicher, R. Viti, F. Coletti, G. Guglielmi, C. Battista, V. Carnevale, L. Iorio, P. Beck-Peccoz, M. Arosio, B. Ambrosi, A. Scillitani, Bone mineral density, prevalence of vertebral fractures, and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism:an Italian multicenter study. J. Clin. Endocrinol. Metab. 94(9), 3207–3214 (2009)

    Article  PubMed  CAS  Google Scholar 

  41. M. Lunt, P. Masaryk, C. Scheidt-Nave, J. Nijs, G. Poor, H. Pols, J.A. Falch, G. Hammermeister, D.M. Reid, L. Benevolenskaya, K. Weber, J. Cannata, T.W. O’Neill, D. Felsenberg, A.J. Silman, J. Reeve, The effects of lifestyle, dietary dairy intake and diabetes on bone density and vertebral deformity prevalence: the EVOS Study. Osteoporos. Int. 12, 688–698 (2001)

    Article  PubMed  CAS  Google Scholar 

  42. K.C. Chiu, A. Chu, V.L. Go, M.F. Saad, Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am. J. Clin. Nutr. 79, 820–825 (2004)

    PubMed  CAS  Google Scholar 

  43. S. Kumar, M. Davies, Y. Zakaria, E.B. Mawer, C. Gordon, A.O. Olukoga, A.J. Boulton, Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D. Postgrad. Med. J. 70, 440–443 (1994)

    Article  PubMed  CAS  Google Scholar 

  44. A. Zittermann, Vitamin D in preventive medicine: are we ignoring the evidence? Br. J. Nutr. 89, 552–572 (2003)

    Article  PubMed  CAS  Google Scholar 

  45. D.D. Bikle, Clinical counterpoint: vitamin D: new actions, new analogs, new therapeutic potential. Endocr. Rev. 13, 765–784 (1992)

    PubMed  CAS  Google Scholar 

  46. J.J. Cao, Effects of obesity on bone metabolism. J. Orthop. Surg. Res. 15, 6–30 (2011)

    Google Scholar 

  47. G. Musso, Non-alcoholic fatty liver, adipose tissue, and the bone: a new triumvirate on the block. Endocrine 42(2), 237–239 (2012)

    Article  PubMed  CAS  Google Scholar 

  48. G. Mazziotti, J. Bilezikian, E. Canalis, D. Cocchi, A. Giustina, New understanding and treatments for osteoporosis. Endocrine 41(1), 58–69 (2012)

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

CDS researched and analyzed data and drafted the manuscript. AF, NT, and MA performed the clinical investigation. LV, PC, and SS gathered the data. CA critically revised the manuscript. MR contributed to the study design, to performing statistics, and drafting manuscript. All Authors read and approved the final manuscript.

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The authors declare that they have no competing interests, and no potential conflicts of interest relevant to this article were reported.

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Correspondence to C. Di Somma.

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Di Somma, C., Rubino, M., Faggiano, A. et al. Spinal deformity index in patients with type 2 diabetes. Endocrine 43, 651–658 (2013). https://doi.org/10.1007/s12020-012-9848-z

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