Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus.
We found that type 2 diabetes mellitus (T2DM) was associated with increased fracture risks in non-obese postmenopausal Chinese women, and suppressed bone turnover might be the underlying mechanism. This is the first study evaluating and explaining the association of T2DM with osteoporotic fracture in Chinese population with such high homogeneity.


BACKGROUND
The aim of this study was to investigate the association of T2DM with osteoporotic fracture in postmenopausal Chinese women.


METHODS
One thousand four hundred ten postmenopausal women were included and stratified into non-obese population [body mass index (BMI) < 25 kg/m(2)] and obese population (BMI ≥ 25 kg/m(2)). Each type of population was classified into diabetes group, impaired fasting glucose (IFG) group, and normal glucose group. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Serum C-terminal telopeptide of type I collagen (β-CTX) and serum N-amino terminal prepeptide of type 1 procollagen (P1NP) were quantified. Vertebral fractures (VFs) and non-VFs were assessed by vertebral X-ray and questionnaire, respectively.


RESULTS
Comparing to normal glucose group, diabetes group and IFG group both had lower levels of P1NP and β-CTX, despite population types. Despite having non-decreased BMD, non-obese diabetic patients had higher risks of total fracture and VF than BMI-matched normal glucose subjects (both P < 0.05). Non-obese population was further classified by a mean value of P1NP or β-CTX. Non-obese diabetic patients with low P1NP or high β-CTX had higher fracture risks (both P < 0.05), comparing to non-obese normal glucose subjects with high P1NP or high β-CTX, respectively.


CONCLUSIONS
Type 2 diabetic patients had suppressed bone turnover, which might explain the increased fracture risks, independent of BMD. IFG patients might also have poor bone quality and need early prevention.
Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, China.
R
R
Jiajue
Y
Y
Jiang
O
O
Wang
M
M
Li
X
X
Xing
L
L
Cui
J
J
Yin
L
L
Xu
W
W
Xia
D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology*; D002681:China / Q000453:epidemiology; D024042:Collagen Type I / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D015995:Prevalence; D011347:Procollagen / Q000097:blood
D015415:Biomarkers; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide