title: Bone mineral density and risk of fractures in aging, obese post-menopausal women with type 2 diabetes. The GIUMO Study.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (DM) has a high prevalence in aging obese postmenopausal women. It is not clear whether or not diabetes produces an increase in bone mineral density or an increase in fracture rates.
  
  
  OBJECTIVE
  The main objective of this study was to investigate whether type 2 DM produces a higher prevalence of vertebral, hip and non-vertebral fractures in obese postmenopausal Caucasian women. A secondary objective was to study the influence of DM in quantitative ultrasound measurements of the heel (QUS) and bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA), in both lumbar spine (L2-L4) and proximal femur.
  
  
  METHODS
  This study was a prospective cohort of 111 patients with type 2 DM and 91 control individuals (CTR) over age 65 and obese, recruited from 16 centers in Spain.
  
  
  METHODS
  Lateral dorsal and lumbar X-rays were performed to assess vertebral fractures. Hip and non-vertebral fractures were noted from medical records, written reports or Xray studies. QUS measurements were made of the calcaneus and BMD measurements of the lumbar spine (L2-L4) and proximal femur.
  
  
  RESULTS
  Patients had higher BMD in the lumbar spine (L2-L4) than controls (0.979 g/cm2 vs 0.927 g/cm2, p=0.035), but we found no statistically significant differences in the proximal femur. QUS measurements showed similar values in both groups: BUA (69.3 dB/Mhz vs 66.7 dB/Mhz, p=0.291), SOS (1537 m/sg vs 1532 m/sg, p=0.249) and QUI (87.5 vs 83.7, p=0.153). No statistically significant differences were found in any case. There was no association between vertebral, hip and non-vertebral fractures and DM. The crude odds ratio, without adjusting was 1.045 (CI 95% 0.531 ; 2.059), and the adjusted odds ratio was 0.927 (CI 95% 0.461 ; 1.863).
  
  
  CONCLUSIONS
  In obese postmenopausal Caucasian women, type 2 DM produces an increase in BMD of the lumbar spine without changes in BMD of the proximal femur or in QUS measurements of the heel. The prevalence of vertebral, hip and non-vertebral fractures did not increase in type 2 DM.
authors.affiliation: University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Hospital University Insular, Bone Metabolic Unit, Las Palmas de Gran Canaria, Canary Islands, Spain. msosa@ono.com
authors.forename: Manuel
authors.initials: M
authors.lastname: Sosa
authors.forename: Pedro
authors.initials: P
authors.lastname: Saavedra
authors.forename: Esteban
authors.initials: E
authors.lastname: Jódar
authors.forename: Carlos
authors.initials: C
authors.lastname: Lozano-Tonkin
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Quesada
authors.forename: Antonio
authors.initials: A
authors.lastname: Torrijos
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez-Cano
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogués
authors.forename: Manuel
authors.initials: M
authors.lastname: Díaz-Curiel
authors.forename: Manuel Jesús
authors.initials: MJ
authors.lastname: Moro
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez
authors.forename: José
authors.initials: J
authors.lastname: Mosquera
authors.forename: Javier
authors.initials: J
authors.lastname: Alegre
authors.forename: José
authors.initials: J
authors.lastname: Olmos
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz-Torres
authors.forename: Nuria
authors.initials: N
authors.lastname: Guañabens
authors.forename: Javier
authors.initials: J
authors.lastname: Del Pino
authors.forename: Federico
authors.initials: F
authors.lastname: Hawkins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D015519:Bone Density; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D005269:Femur / Q000737:chemistry; D050723:Fractures, Bone / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008159:Lumbar Vertebrae / Q000737:chemistry / Q000473:pathology; D009765:Obesity / Q000097:blood / Q000150:complications*; D017698:Postmenopause; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D044465:White People
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human