Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 1/2018

01-01-2018 | Original Article

Effects of obesity and diabetes on rate of bone density loss

Authors: W. D. Leslie, S. N. Morin, S. R. Majumdar, L. M. Lix

Published in: Osteoporosis International | Issue 1/2018

Login to get access

Abstract

Summary

In this large registry-based study, women with diabetes had marginally greater bone mineral density (BMD) loss at the femoral neck but not at other measurement sites, whereas obesity was not associated with greater BMD loss. Our data do not support the hypothesis that rapid BMD loss explains the increased fracture risk associated with type 2 diabetes and obesity observed in prior studies.

Introduction

Type 2 diabetes and obesity are associated with higher bone mineral density (BMD) which may be less protective against fracture than previously assumed. Inconsistent data suggest that rapid BMD loss may be a contributing factor.

Methods

We examined the rate of BMD loss in women with diabetes and/or obesity in a population-based BMD registry for Manitoba, Canada. We identified 4960 women aged ≥ 40 years undergoing baseline and follow-up BMD assessments (mean interval 4.3 years) without confounding medication use or large weight fluctuation. We calculated annualized rate of BMD change for the lumbar spine, total hip, and femoral neck in relation to diagnosed diabetes and body mass index (BMI) category.

Results

Baseline age-adjusted BMD was greater in women with diabetes and for increasing BMI category (all P < 0.001). In women with diabetes, unadjusted BMD loss was less at the lumbar spine (P = 0.017), non-significantly greater at the femoral neck (P = 0.085), and similar at the total hip (P = 0.488). When adjusted for age and BMI, diabetes was associated with slightly greater femoral neck BMD loss (− 0.0018 g/cm2/year, P = 0.012) but not at the lumbar spine or total hip. There was a strong linear effect of increasing BMI on attenuated BMI loss at the lumbar spine with negligible effects on hip BMD.

Conclusions

Diabetes was associated with slightly greater BMD loss at the femoral neck but not at other measurement sites. BMD loss at the lumbar spine was reduced in overweight and obese women but BMI did not significantly affect hip BMD loss.
Literature
1.
Schwartz AV, Vittinghoff E, Bauer DC, Hillier TA, Strotmeyer ES, Ensrud KE et al (2011) Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 305(21):2184–2192CrossRefPubMedPubMedCentral
2.
Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E et al (2012) FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 27(2):301–308CrossRefPubMed
3.
Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S et al (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124(11):1043–1050CrossRefPubMedPubMedCentral
4.
Prieto-Alhambra D, Premaor MO, Fina AF, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C et al (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27(2):294–300CrossRefPubMed
5.
Ishii S, Cauley JA, Greendale GA, Nielsen C, Karvonen-Gutierrez C, Ruppert K et al (2014) Pleiotropic effects of obesity on fracture risk: the Study of Women’s Health Across the Nation. J Bone Miner Res 29(12):2561–2570CrossRefPubMedPubMedCentral
6.
Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV et al (2006) Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 55(6):1813–1818CrossRefPubMed
7.
Barrett-Connor E, Weiss TW, McHorney CA, Miller PD, Siris ES (2009) Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 20(5):715–722CrossRefPubMed
8.
Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE et al (2002) Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 25(10):1749–1754CrossRefPubMed
9.
Beck TJ, Petit MA, Wu G, Leboff MS, Cauley JA, Chen Z (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the Women’s Health Initiative Observational Study. J Bone Miner Res 24(8):1369–1379CrossRefPubMedPubMedCentral
10.
Scott D, Seibel M, Cumming R, Naganathan V, Blyth F, Le Couteur DG et al (2017) Sarcopenic obesity and its temporal associations with changes in bone mineral density, incident falls, and fractures in older men: the Concord Health and Ageing in Men Project. J Bone Miner Res 32(3):575–583CrossRefPubMed
11.
12.
Saito M, Kida Y, Kato S, Marumo K (2014) Diabetes, collagen, and bone quality. Curr Osteoporos Rep 12(2):181–188CrossRefPubMed
13.
Burghardt AJ, Issever AS, Schwartz AV, Davis KA, Masharani U, Majumdar S et al (2010) High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 95(11):5045–5055CrossRefPubMedPubMedCentral
14.
Schwartz AV, Sellmeyer DE, Strotmeyer ES, Tylavsky FA, Feingold KR, Resnick HE et al (2005) Diabetes and bone loss at the hip in older black and white adults. J Bone Miner Res 20(4):596–603CrossRefPubMed
15.
Strotmeyer ES, Boudreau RM, Marshall LM, Schwartz AV, Bauer DC, Barrett-Connor E et al (2008) Higher bone mineral density loss in older men with diabetes: the Osteoporotic Fractures in Men Study. J Bone Miner Res 23(Suppl 1):S59
16.
Gilbert MP, Pratley RE (2015) The impact of diabetes and diabetes medications on bone health. Endocr Rev 36(2):194–213CrossRefPubMed
17.
Bolland MJ, Grey AB, Ames RW, Horne AM, Gamble GD, Reid IR (2005) Fat mass is an important predictor of parathyroid hormone levels in postmenopausal women. Bone 38(3):317–321CrossRefPubMed
18.
Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6(3):275–282CrossRefPubMed
19.
Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8(1):25–30CrossRefPubMed
20.
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5):468–489CrossRefPubMed
21.
Blanchard JF, Ludwig S, Wajda A, Dean H, Anderson K, Kendall O et al (1996) Incidence and prevalence of diabetes in Manitoba, 1986-1991. Diabetes Care 19(8):807–811CrossRefPubMed
22.
Lix L, Yogendran M, Shaw S, Burchill C, Metge C, Bond R (2008) Population-based data sources for chronic disease surveillance. Chronic Dis Can 29(1):31–38PubMed
23.
Lix LM, Azimaee M, Osman BA, Caetano P, Morin S, Metge C et al (2012) Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health 12:301CrossRefPubMedPubMedCentral
24.
O’Donnell S, Canadian Chronic Disease Surveillance System Osteoporosis Working Group (2013) Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study. Arch Osteoporos 8:143CrossRefPubMedPubMedCentral
25.
Kozyrskyj AL, Mustard CA (1998) Validation of an electronic, population-based prescription database. Ann Pharmacother 32(11):1152–1157CrossRefPubMed
26.
Hastie TJ, Tibshirani RJ 1990 Generalized additive models. Chapman & Hall/CRC Monographs on Statistics & Applied Probability, Boca Raton
27.
Schwartz AV, Ewing SK, Porzig AM, McCulloch CE, Resnick HE, Hillier TA et al (2013) Diabetes and change in bone mineral density at the hip, calcaneus, spine, and radius in older women. Front Endocrinol (Lausanne) 4:62PubMedCentral
28.
Khalil N, Sutton-Tyrrell K, Strotmeyer ES, Greendale GA, Vuga M, Selzer F et al (2011) Menopausal bone changes and incident fractures in diabetic women: a cohort study. Osteoporos Int 22(5):1367–1376CrossRefPubMed
29.
Keegan TH, Schwartz AV, Bauer DC, Sellmeyer DE, Kelsey JL (2004) Fracture intervention t. Effect of alendronate on bone mineral density and biochemical markers of bone turnover in type 2 diabetic women: the fracture intervention trial. Diabetes Care 27(7):1547–1553CrossRefPubMed
30.
Krakauer JC, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM (1995) Bone loss and bone turnover in diabetes. Diabetes 44(7):775–782CrossRefPubMed
31.
Hygum K, Starup-Linde J, Harslof T, Vestergaard P, Langdahl BL (2017) Diabetes mellitus, a state of low bone turnover—a systematic review and meta-analysis. Eur J Endocrinol 176(3):R137–RR57CrossRefPubMed
32.
Garcia-Martin A, Rozas-Moreno P, Reyes-Garcia R, Morales-Santana S, Garcia-Fontana B, Garcia-Salcedo JA et al (2012) Circulating levels of sclerostin are increased in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 97(1):234–241CrossRefPubMed
33.
Lloyd JT, Alley DE, Hochberg MC, Waldstein SR, Harris TB, Kritchevsky SB et al (2016) Changes in bone mineral density over time by body mass index in the health ABC study. Osteoporos Int 27(6):2109–2116CrossRefPubMed
34.
Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ et al (2012) Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res 27(1):111–118CrossRefPubMedPubMedCentral
35.
Jones G, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1995) A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 22(5):932–936PubMed
36.
Yu EW, Bouxsein ML, Roy AE, Baldwin C, Cange A, Neer RM et al (2014) Bone loss after bariatric surgery: discordant results between DXA and QCT bone density. J Bone Miner Res 29(3):542–550CrossRefPubMedPubMedCentral
37.
Binkley N, Krueger D, Vallarta-Ast N (2003) An overlying fat panniculus affects femur bone mass measurement. J Clin Densitom 6(3):199–204CrossRefPubMed
38.
Berger C, Langsetmo L, Joseph L, Hanley DA, Davison KS, Josse R et al (2008) Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents. CMAJ 178(13):1660–1668CrossRefPubMedPubMedCentral
Metadata
Title
Effects of obesity and diabetes on rate of bone density loss
Authors
W. D. Leslie
S. N. Morin
S. R. Majumdar
L. M. Lix
Publication date
01-01-2018
Publisher
Springer London
Published in
Osteoporosis International / Issue 1/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-017-4223-9

Other articles of this Issue 1/2018

Osteoporosis International 1/2018 Go to the issue

Original Article

The effect of high-dose vitamin D3 supplementation on bone mineral density in subjects with prediabetes

Original Article

Prediction of major osteoporotic and hip fractures in Australian men using FRAX scores adjusted with trabecular bone score

Letter

Comments on Li et al.: Meta-analysis of hypertension and osteoporotic fracture risk in women and men

Letter

Administrative health data: guilty until proven innocent. Response to comments by Levy and Sobolev

Original Article

Analysis of the evolution of cortical and trabecular bone compartments in the proximal femur after spinal cord injury by 3D-DXA

Original Article

Two-year cortical and trabecular bone loss in CKD-5D: biochemical and clinical predictors