Poor Glycemic Control Tied to Bone Formation in Younger Women With Type 2 Diabetes

By David Douglas

October 27, 2019

NEW YORK (Reuters Health) - Bone histomorphometry suggests that in premenopausal women with type 2 diabetes mellitus (T2DM) glycemic control is associated with bone remodeling, and may increase fracture risk, according to researchers in Brazil.

"T2DM is classically associated with chronic complications affecting the kidneys, retina and nerves. Our study proves for the first time that poor control of T2DM can affect bone quality by reducing bone formation," said Dr. Vicente F. C. Andrade of the Federal University of Parana, in Curitaba.

"In addition," he told Reuters Health by email, "the presence of chronic complications (retinopathy and diabetic nephropathy) is associated with more severe bone disease, also affecting bone mineralization."

Osteoporosis has been recently identified as a chronic complication in those with T2DM, Dr. Andrade and his colleagues point out in the Journal of Clinical Endocrinology and Metabolism, online October 9.

This could lead to a greater risk of fractures, they add. However, the team suggests that bone quality rather than a bone mineral density (BMD) deficit could be at the root of this problem.

To investigate, they studied 26 women with T2DM and a mean age 41.6 years. Ten had HbA1c below 7% and were deemed to have good glycemic control, while the remaining 16 with higher HbA1c were considered to have poor control.

Nine patients had chronic complications; seven had early diabetic retinopathy, three had incipient diabetic nephropathy and one had both retinopathy and nephropathy.

All patients underwent bone biopsies. As a control group for histomorphometric parameters, bone biopsies were also obtained postmortem from 15 premenopausal, previously healthy women.

Compared with controls, bone volume was significantly increased in diabetic women, but osteoide thickness was significantly lower. This suggests "a more robust bone microstructure," the researchers say.

The findings, they add, "are also consistent with studies demonstrating that patients with diabetes have increased BMD values compared with the normal population."

Comparison of groups with and without chronic complications showed that osteoide thickness was reduced in those with poor control compared with those with good control, and bone volume was similar to that in the control group.

There was also a significant negative correlation between HbA1c and osteoide thickness and osteoide surface.

These bone changes "contribute to reduced bone quality and may justify an increased risk of fractures in patients with T2DM," the researchers write.

SOURCE: https://bit.ly/2N7taMl

J Clin Metab Endocrinol 2019.