title: Associations between components of the metabolic syndrome versus bone mineral density and vertebral fractures in patients with type 2 diabetes.
abstract: The association of bone with the metabolic syndrome and its features, visceral fat accumulation or insulin resistance, remains unclear. We determined visceral and subcutaneous fat areas (V and S) by computed tomography on 187 men (28-83 years) and 125 postmenopausal women (46-82 years) with type 2 diabetes. Men whose V was 100 cm(2) or more had significantly lower urinary N-terminal cross-linked telopeptide of type-I collagen (p=0.005), higher femoral neck bone mineral density (FN-BMD) (p=0.004), and lower prevalence of vertebral fractures (VFs) (p=0.04) than controls. Fat mass, V, S, and lean body mass positively correlated with FN-BMD in men and with lumbar (L) and FN-BMD in women. When adjusted for weight, these correlations became negative. Urinary C-peptide positively correlated with FN-BMD in both genders. Multivariate logistic regression analysis adjusted for age, height, weight, L-BMD, duration of diabetes, and diabetes therapies identified V in men and urinary C-peptide in women as factors inversely associated with the presence of VFs [odds ratio (OR)=0.61 per SD increase, p=0.04, and OR=0.32, p=0.01, respectively]. These findings suggest that, of the components of the metabolic syndrome, body fat in gravity and hyperinsulinemia could increase FN-BMD in diabetic subjects. Visceral fat in men and hyperinsulinemia in women may protect against VFs independent of weight, L-BMD, diabetes duration, or therapies.
authors.affiliation: Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan. yamaguch@med.shimane-u.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Ippei
authors.initials: I
authors.lastname: Kanazawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Soichi
authors.initials: S
authors.lastname: Kurioka
authors.forename: Mika
authors.initials: M
authors.lastname: Yamauchi
authors.forename: Shozo
authors.initials: S
authors.lastname: Yano
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications; D015519:Bone Density / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology*; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications; D016103:Spinal Fractures / Q000150:complications* / Q000503:physiopathology*