title: Pentosidine and increased fracture risk in older adults with type 2 diabetes.
abstract: BACKGROUND
  Type 2 diabetes is associated with higher fracture risk at a given bone mineral density. Advanced glycation endproducts (AGEs) accumulate in bone collagen with age and diabetes and may weaken bone.
  
  
  OBJECTIVE
  The aim was to determine whether urine pentosidine, an AGE, was associated with fractures in older adults with and without diabetes.
  
  
  METHODS
  We performed an observational cohort study.
  
  
  METHODS
  We used data from the Health, Aging and Body Composition prospective study of white and black, well-functioning men and women ages 70-79 yr.
  
  
  METHODS
  Participants with (n = 501) and without (n = 427) diabetes were matched on gender, race, and study site.
  
  
  METHODS
  Urine pentosidine was assayed from frozen stored baseline specimens.
  
  
  METHODS
  Incident clinical fractures and baseline vertebral fractures were measured.
  
  
  RESULTS
  Despite higher bone mineral density, clinical fracture incidence (14.8 vs. 12.6%) and vertebral fracture prevalence (2.3 vs. 2.9%) were not lower in those with diabetes (P > 0.05). In multivariable models, pentosidine was associated with increased clinical fracture incidence in those with diabetes [relative hazard, 1.42; 95% confidence interval (CI), 1.10, 1.83, for 1 sd increase in log pentosidine] but not in those without diabetes (relative hazard, 1.08; 95% CI, 0.79, 1.49; P value for interaction = 0.030). In those with diabetes, pentosidine was associated with increased vertebral fracture prevalence (adjusted odds ratio, 5.93; 95% CI, 2.08, 16.94, for 1 sd increase in log pentosidine) but not in those without diabetes (adjusted odds ratio, 0.74; 95% CI, 0.30, 1.83; P value for interaction = 0.005).
  
  
  CONCLUSIONS
  Higher pentosidine levels are a risk factor for fracture in older adults with diabetes and may account in part for reduced bone strength in type 2 diabetes.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94107-1762, USA. Aschwartz@psg.ucsf.edu
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Patrick
authors.initials: P
authors.lastname: Garnero
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Sellmeyer
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Feingold
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Frances A
authors.initials: FA
authors.lastname: Tylavsky
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000032:analysis / Q000652:urine; D015519:Bone Density; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000652:urine; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000652:urine; D006801:Humans; D015994:Incidence; D008239:Lysine / Q000031:analogs & derivatives* / Q000032:analysis / Q000652:urine; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology / Q000652:urine
chemical_list: D001120:Arginine; C062187:pentosidine; D008239:Lysine