Correlation between bone and glucide metabolism depending on the nutritional status in diabetic patients

Abstract

Background: Diabetes mellitus and low-trauma fractures are major causes of morbidity and mortality worldwide. The objective is to evaluate the relationship between nutritional status, dairy calcium intake, serum levels of vitamin D, glycemic control and the onset of osteoporosis and/or bone fractures predisposition in T1DM and T2DM patients. Methods: The sample consists of 1151 patients (350 men and 799 women) divided into three groups: 400 patients with T1DM of which 19 with osteoporosis (age 42,39 ±13.66 yo; BMI 23,88±3,28), 401 patients with T2DM of which 64 with osteoporosis (age 62.01±13.21 yo; BMI 30,25±8,83), 350 non-diabetic patients with osteopo-rosis (NDP) (age 64.59±10.45 yo; BMI 25,64±4,17). In all subjects nutritional status, anthropometric, metabolic and glycemic control parameters, BMD (as T-score) at the lumbar spine (LS-BMD), femoral neck (FN-BMD) and total femur (Ftot-BMD) were measured. Prevalence of bone fracture between the different groups were determined. Results: Low vitamin D levels were found in both T1DM (16.38±2.74 ng/mL) and T2DM (15.04±9.35 ng/mL) as well as low daily calcium intake (634.84±159.97 mg/day and 649.43±189.86 mg/day, respectively). About 89% of T1DM and 37,5% of T2DM had T-score≥-2,5; T1DM had also a FN-BMD (T-score:-2.373±0.68 vs.-1.91±0.72; p=0.016) and Ftot-BMD (T-score:-2.368±0.79 vs.-1.60 ±0.96; p=0.003) significantly lower than T2DM and a LS-BMD significantly lower compared to NDP (T-score:-2.26±0.79 vs.-2.91±0.86). Instead, T2DM had a LS-BMD, FN-BMD and Ftot-BMD significantly higher than those of NDP (p=0.0001, p=0.004, p=0.007). We did not found a positive correlation between BMD and HBA1c. 1% of TIDM, 3.2% of T2DM and 14.8% of NDP had vertebral fractures; 22.7%, 9.2% and 14% had non-vertebral fractures. T2DM had 38% reduction in risk of non-vertebral fractures (OR 0.62, 95% CI=0.39-0.98) compared with controls; instead, T1DM had an increased risk of non-vertebral fractures (OR 1.81, 95% CI 1.24-2.66). Conclusions: We confirm that T1D had an increased risk of fractures. Calcium intake and vitamin D resulted insufficient in all groups. HBA1c did not affect BMD or risk of fractures in all groups.