Hypogonadal men with type 2 diabetes mellitus have smaller bone size and lower bone turnover.
Both hypogonadism and type 2 diabetes mellitus (T2D) are associated with increased fracture risk. Emerging data support the negative effect of low testosterone on glucose metabolism, however, there is little information on the bone health of hypogonadal men with diabetes. We evaluated the bone mineral density (BMD), bone geometry and bone turnover of hypogonadal men with T2D compared to hypogonadal men without diabetes.



Cross-sectional study, men 40-74years old, with average morning testosterone (done twice) of<300ng/dl. Areal BMD (aBMD) was measured by DXA; volumetric BMD (vBMD) and bone geometry by peripheral-quantitative-computed-tomography; serum C-telopeptide (CTX), osteocalcin, sclerostin and sex hormone-binding globulin (SHBG) by ELISA, testosterone and 25-hydroxyvitamin D (25OHD) by automated immunoassay and estradiol by liquid-chromatography/mass-spectrometry. Groups were compared by ANOVA adjusted for covariates.



One-hundred five men, 49 with and 56 without diabetes were enrolled. Adjusted vBMD at 38% tibia was higher in diabetic than non-diabetic men (857.3±69.0mg/cm3vs. 828.7±96.7mg/cm3, p=0.02). Endosteal (43.9±5.8mm vs. 47.1±7.8mm, p=0.04) and periosteal (78.4±5.0mm vs. 81.3±6.5mm, p=0.02) circumferences and total area (491.0±61.0mm2vs. 527.7±87.2mm2, p=0.02) at 38% tibia, were lower in diabetic men even after adjustments for covariates. CTX (0.25±0.14ng/ml vs. 0.40±0.19ng/ml, p<0.001) and osteocalcin (4.8±2.8ng/ml vs. 6.8±3.5ng/ml, p=0.006) were lower in diabetic men; there were no differences in sclerostin and 25OHD. Circulating gonadal hormones were comparable between the groups.



Among hypogonadal men, those with T2D have higher BMD, poorer bone geometry and relatively suppressed bone turnover. Studies with larger sample size are needed to verify our findings and possible even greater risk for fractures among hypogonadal diabetic men.
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA; University Campus Biomedico of Rome, Via Alvaro del Portillo, 21 04000100, Rome, Italy.
Georgia
G
Colleluori
New Mexico VA Health Care System, 1501 San Pedro SE, 87108 Albuquerque, NM, USA.
Lina
L
Aguirre
New Mexico VA Health Care System, 1501 San Pedro SE, 87108 Albuquerque, NM, USA; University of New Mexico School of Medicine, 87131 Albuquerque, NM, USA.
Richard
R
Dorin
New Mexico VA Health Care System, 1501 San Pedro SE, 87108 Albuquerque, NM, USA; University of New Mexico School of Medicine, 87131 Albuquerque, NM, USA.
David
D
Robbins
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA.
Dean
D
Blevins
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA.
Yoann
Y
Barnouin
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA.
Rui
R
Chen
University of New Mexico School of Medicine, 87131 Albuquerque, NM, USA; Biomedical Research Institute of New Mexico, 1501 San Pedro SE, 87108 Albuquerque, NM, USA.
Clifford
C
Qualls
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA.
Dennis T
DT
Villareal
Baylor College of Medicine, One Baylor Plaza, 77030 Houston, TX, USA; Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, 77030 Houston, TX, USA. Electronic address: Reina.Villareal@bcm.edu.
Reina
R
Armamento-Villareal
D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology*; D001842:Bone and Bones / Q000033:anatomy & histology* / Q000378:metabolism*; D024042:Collagen Type I / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000378:metabolism*; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010455:Peptides / Q000097:blood; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D024042:Collagen Type I; D010455:Peptides; D012738:Sex Hormone-Binding Globulin; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D014807:Vitamin D; D013739:Testosterone; C104450:25-hydroxyvitamin D
Bone; Bone geometry; Hypogonadism; T2D; Testosterone