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Journal of Bone and Mineral Metabolism
Published in: Journal of Bone and Mineral Metabolism 4/2019

01-07-2019 | Original Article

Overweight and underweight are risk factors for vertebral fractures in patients with type 2 diabetes mellitus

Authors: Ippei Kanazawa, Masakazu Notsu, Ayumu Takeno, Ken-ichiro Tanaka, Toshitsugu Sugimoto

Published in: Journal of Bone and Mineral Metabolism | Issue 4/2019

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Abstract

The aim of this cross-sectional study was to examine the association between body mass index (BMI) and the prevalence of vertebral fracture (VF) in Japanese patients with type 2 diabetes (T2DM). A total of 798 patients with T2DM were enrolled. VF was determined semi-quantitatively using lateral X-ray films. The association between BMI quartiles (Q1: ≤ 21.2 kg/m2, Q2: 21.3–23.4 kg/m2, Q3: 23.5–25.8 kg/m2, Q4: 25.9≤ kg/m2) and the presence of VF was examined. Multiple logistic regression analyses adjusted for age, sex, diabetes duration, hemoglobin A1c (HbA1c), estimated glomerular filtration rate, and albumin showed that Q1, Q3, and Q4 were significantly associated with an increased VF risk compared to Q2, which served as a reference [Q1; odds ratio (OR) = 1.91, 95% confidence interval (CI) 1.24–2.95, p = 0.004, Q3; OR = 1.65, 95% CI 1.07–2.55, p = 0.023, and Q4; OR = 2.18, 95% CI 1.39–3.41, p < 0.001]. Moreover, these associations remained significant after additional adjustment for femoral neck T-score, a bone resorption marker, urinary N-terminal cross-linked telopeptide of type-I collagen, and use of insulin and thiazolidinedione. Our study shows for the first time that both overweight and underweight were associated with the bone mineral density (BMD)-independent risk of VF in patients with T2DM. Therefore, body weight control should be considered as a protective measure against diabetes-related bone fragility.
Literature
1.
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882CrossRefPubMed
2.
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefPubMed
3.
Cauley JA, Lui LY, Paudel ML, Taylor BC, Cawthon PM, Hillier TA, Schousboe JT, McCulloch CE, Ensrud KE (2016) Impact of radiographic vertebral fractures on inpatient healthcare utilization in older women. Bone 88:165–169CrossRefPubMedPubMedCentral
4.
Yamaguchi T, Sugimoto T, Yamada H, Kanzawa M, YanoS Yamauchi M, Chihara K (2002) The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int 13:331–336CrossRefPubMed
5.
Yamaguchi T, Sugimoto T, Yamauchi M, Matsumori Y, Tsutsumi M, Chihara K (2005) Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women. J Bone Miner Metab 23:36–40CrossRefPubMed
6.
Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444CrossRefPubMed
7.
Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2009) Diabetic patients have an increased risk of vertebral fractures independent of bone mineral density or diabetic complications. J Bone Miner Res 24:702–709CrossRefPubMed
8.
Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505CrossRefPubMed
9.
Wang J, You W, Jing Z, Wang R, Fu Z, Wang Y (2016) Increased risk of vertebral fracture in patients with diabetes: a meta-analysis of cohort studies. Int Orthop 40:1299–1307CrossRefPubMed
10.
Miyake H, Kanazawa I, Sugimoto T (2018) Association of bone mineral density, bone turnover markers, and vertebral fractures with all-cause mortality in type 2 diabetes mellitus. Calcif Tissue Int 102:1–13CrossRef
11.
Kanazawa I, Takeno A, Tanaka KI, Yamane Y, Sugimoto T (2018) Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus. J Bone Miner Metab. https://​doi.​org/​10.​1007/​s00774-018-0948-6
12.
De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton JL 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338CrossRefPubMed
13.
Holmberg AH, Johnell O, Nilsson PM, Nilsson J, Berglund G, Akesson K (2006) Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int 17:1065–1077CrossRefPubMed
14.
Chan M, Frost SA, Center JR, Eisman JA, Nguyen TV (2014) Relationship between body mass index and fracture risk is mediated by bone mineral density. J Bone Miner Res 29:2323–2326CrossRef
15.
Johansson H, Kanis JA, Oden A, McCloskey E, Chapurlat RD, Christiansen C, Cummings SR, Diez-Perez A, Eisman JA, Fujiwara S, Gluer CC, Goltzman D, Hans D, Khaw KT, Krieg MA, Kroger H, LaCroix AZ, Lau E, Leslie WD, Mellstrom D, Melton LJ 3rd, O’Neill TW, Pasco JA, Prior JC, Reid DM, Rivadeneira F, van Staa T, Yoshimura N, Zillikens MC (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233CrossRefPubMed
16.
Pirro M, Fabbriciani G, Leli C, Callarelli L, Manfredelli MR, Fioroni C, Mannarino MR, Scarponi AM, Mannarino E (2010) High weight or body mass index increase the risk of vertebral fractures in postmenopausal osteoporotic women. J Bone Miner Metab 28:88–93CrossRefPubMed
17.
Nielson CM, Srikanth P, Orwoll ES (2012) Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res 27:1–10CrossRefPubMed
18.
Laslett LL, Just Nee Foley SJ, Quinn SJ, Winzenberg TM, Jones G (2012) Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporos Int 23:67–74CrossRefPubMed
19.
Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, Saag KG, Roux C, Rossini M, Pfeilschifter J, Nieves JW, Netelenbos JC, March L, LaCroix AZ, Hooven FH, Greenspan SL, Gehlback SH, Diez-Perez A, Cooper C, Chapurlat RD, Boonen S, Anderson FA Jr, Adami S, Adachi JD, Investigators GLOW (2014) Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res 29:487–493CrossRefPubMedPubMedCentral
20.
Roy DK, O’Neil TW, Finn JD, Lunt M, Silman AJ, Felsenberg D, Armbrecht G, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Degueker J, Diaz MN, Eastell R, Yershova OB, Felsch B, Gowin W, Havelka S, Hoszowski K, Ismail AA, Jajic I, Janott I, Johnell O, Kanis JA, Kragl G, Lopez Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Gennari C, Pols HA, Poor G, Raspe HH, Reid DM, Reisinger W, Scheidt-Nave C, Stepan JJ, Todd CJ, Weber K, Woolf AD, Reeve J, European Prospective Osteoporosis Study (EPOS) (2003) Determinants of incident vertebral fracture in men and women: results from the European prospective osteoporosis study. Osteoporos Int 14:19–26CrossRefPubMed
21.
Kanazawa I, Yamaguchi T, Sugimoto T (2011) Serum insulin-like growth factor-I is a marker for assessing the severity of vertebral fractures in postmenopausal women with type 2 diabetes mellitus. Osteoporos Int 22:1191–1198CrossRefPubMed
22.
Kanazawa I, Yamaguchi T, Yamamoto M, Yamauchi M, Yano S, Sugimoto Y (2009) Serum osteocalcin/bone-specific alkaline phosphatase ratio is a predictor for the presence of vertebral fractures in men with type 2 diabetes. Calcif Tissue Int 85:228–234CrossRefPubMed
23.
Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 11:984–996CrossRefPubMed
24.
Kaze AD, Rosen HN, Paik JM (2018) A meta-analysis of the association between body mass index and risk of vertebral fracture. Osteoporos Int 29:31–39CrossRefPubMed
25.
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:R137–R157CrossRefPubMed
26.
Kanazawa I, Sugimoto T. Diabetes mellitus-induced bone fragility. Intern Med (in press)
27.
Ravn P, Cizza G, Bjarnason NH, Thompson D, Daley M, Wasnich RD, McClung M, Hosking D, Yates AJ, Christiansen C (1999) Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group. J Bone Miner Res 14:1622–1627CrossRefPubMed
28.
Ricci TA, Heymsfield SB, Pierson RN, Stahl T, Chowdhury HA, Shapses SA (2001) Moderate energy restriction increases bone resorption in obese postmenopausal women. An J Clin Nutr 73:347–352CrossRef
29.
Scotece M, Conde J, Abella V, Lopez V, Pino J, Lago F, Gomez-Reino JJ, Gualillo O (2014) Bone metabolism and adipokines: are there perspectives for bone diseases drug discovery? Expert Opin Drug Discov 9:945–957CrossRefPubMed
30.
31.
Matsubara M, Maruoka S, Katayose S (2002) Inverse relationship between plasma adiponectin and leptin concentrations in normal-weight and obese women. Eur J Endocrinol 147:173–180CrossRefPubMed
32.
Ryan AS, Berman DM, Nicklas BJ, Sinha M, Gingerich RL, Meneilly GS, Egan JM, Elahi D (2003) Plasma adiponectin and leptin levels, body composition, and glucose utilization in adult women with wide ranges of age and obesity. Diabetes Care 26:2383–2388CrossRefPubMed
33.
Kanazawa I, Yamaguchi T, Yano S, Yamauchi M, Yamamoto M, Sugimoto T (2007) Adiponectin and AMP kinase activator stimulate proliferation, differentiation, and mineralization of osteoblastic MC3T3-E1 cells. BMC Cell Biol 8:51CrossRefPubMedPubMedCentral
34.
Luo XH, Guo LJ, Xie H, Yuan LQ, Wu XP, Zhou HD, Liao EY (2006) Adiponectin stimulates RANKL and inhibits OPG expression in human osteoblasts through the MAPK signaling pathway. J Bone Miner Res 21:1648–1656CrossRefPubMed
35.
Kanazawa I, Yamaguchi T, Yamauchi M, Yamamoto M, Kurioka S, Yano S, Sugimoto T (2009) Adiponectin is associated with changes in bone markers during glycemic control in type 2 diabetes mellitus. J Clin Endocrinol Metab 94:3031–3037CrossRefPubMed
36.
Kanazawa I, Yamaguchi T, Yamamoto M, Yamauchi M, Yano S, Sugimoto T (2009) Relationships between serum adiponectin levels versus bone mineral density, bone metabolic markers, and vertebral fractures in type 2 diabetes mellitus. Eur J Endocrinol 160:265–273CrossRefPubMed
37.
Wei J, Ferron M, Clarke CJ, Hannun YA, Jiang H, Blaner WS, Karsenty G (2014) Bone-specific insulin resistance disrupts whole-body glucose homeostasis via decreased osteocalcin activation. J Clin Invest 124:1–13CrossRefPubMed
38.
Shin D, Kim S, Kim KH, Lee K, Park SM (2014) Association between insulin resistance and bone mass in men. J Clin Endocrinol Metab 99:988–995CrossRefPubMed
39.
Cederholm T, Cruz-Jentoft AJ, Maggi S (2013) Sarcopenia and fragility fractures. Eur J Phys Rehabil Med 49:111–117PubMed
40.
Yoshimura N, Muraki S, Oka H, Iidaka T, Kodama R, Kawaguchi H, Nakamura K, Tanaka S, Akune T (2017) Is osteoporosis a predictor for future sarcoepnia or vice versa? Four-year observations between the second and third ROAD study surveys. Osteoporos Int 28:189–199CrossRefPubMed
41.
Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Cho YW, Newman AB, Health, Aging, and Body Composition Study (2007) Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 30:1507–1512CrossRefPubMed
42.
Torrens JI, Skurnick J, Davidow AL, Korenman SG, Santoro N, Soto-Greene M, Lasser N, Weiss G, Study of Women’s Health Across the Nation (SWAN) (2004) Ethnic differences in insulin sensitivity and beta-cell function in premenopausal or early perimenopausal women without diabetes: the Study of Women’s Health Across the Nation (SWAN). Diabetes Care 27:354–361CrossRefPubMed
Metadata
Title
Overweight and underweight are risk factors for vertebral fractures in patients with type 2 diabetes mellitus
Authors
Ippei Kanazawa
Masakazu Notsu
Ayumu Takeno
Ken-ichiro Tanaka
Toshitsugu Sugimoto
Publication date
01-07-2019
Publisher
Springer Japan
Published in
Journal of Bone and Mineral Metabolism / Issue 4/2019
Print ISSN: 0914-8779
Electronic ISSN: 1435-5604
DOI
https://doi.org/10.1007/s00774-018-0960-x

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