title: Acute changes of bone turnover and PTH induced by insulin and glucose: euglycemic and hypoglycemic hyperinsulinemic clamp studies.
abstract: Bone turnover is acutely suppressed after feeding or oral glucose. Insulin infusion suppresses bone turnover and might mediate this effect, but this is confounded by a possible direct effect of hypoglycemia. We examined the effect of euglycemic hyperinsulinemia and hypoglycemic hyperinsulinemia on bone turnover using an insulin clamp. Sixteen men participated in this double-blind crossover study. Clamp induction involved infusion of insulin (80 mU/m(2).min) while maintaining euglycemia (5 mmol/liter) for 40 min with a variable rate dextrose infusion. Glucose was lowered to 2.5 mmol/liter (hypoglycemic clamp) or maintained at 5 mmol/liter (euglycemic clamp) for a further 105 min. Nine controls received a matched saline infusion. Measurements included serum C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide, osteocalcin, and PTH. Induction of hyperinsulinemia resulted in a reduction in PTH (27% +/- 5; P < 0.01), but no significant change in bone turnover from baseline. Hypoglycemic clamp resulted in suppression of serum C-terminal telopeptide of type I collagen by 34% +/- 3, procollagen type I N-terminal propeptide by 15% +/- 1, osteocalcin by 5% +/- 1, and PTH by a further 12% +/- 5 (all P < 0.05). By contrast, there was no significant change in any marker of bone turnover during euglycemic clamp. Postprandial hyperinsulinemia is unlikely to explain the acute suppression of bone turnover with feeding. The reduction in bone turnover during hypoglycemia may be related to hypoglycemia itself, acute changes in PTH, or other hormones released in response to hypoglycemia.
authors.affiliation: Bone Metabolism Group, Division of Clinical Sciences (North), Northern General Hospital, University of Sheffield, Herries Road, Sheffield S5 7 AU, United Kingdom.
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Clowes
authors.forename: Robert T
authors.initials: RT
authors.lastname: Robinson
authors.forename: Simon R
authors.initials: SR
authors.lastname: Heller
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.forename: Aubrey
authors.initials: A
authors.lastname: Blumsohn
mesh_terms: D000328:Adult; D001769:Blood / Q000378:metabolism; D016723:Bone Remodeling / Q000187:drug effects*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D006946:Hyperinsulinism / Q000503:physiopathology; D007003:Hypoglycemia / Q000503:physiopathology; D007328:Insulin / Q000494:pharmacology*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood*; D012016:Reference Values; D013997:Time Factors
chemical_list: D007328:Insulin; D010281:Parathyroid Hormone; D005947:Glucose