In postmenopausal female subjects with type 2 diabetes mellitus, vertebral fractures are independently associated with cortisol secretion and sensitivity

Abstract

Context: In type 2 diabetes (T2D), the vertebral fracture (VFx) prevalence and cortisol secretion are increased. Objective: The objective of this study was to evaluate the role of glucocorticoid secretion and sensitivity in T2D-related osteoporosis. Design and Setting: This was a case-control study in an outpatient setting. Patients: The patients were ninety-nine well-compensated T2D postmenopausal women (age, 65.7 ± 7.3 y) and 107 controls (age, 64.5 ± 8.2 y). Main Outcome Measures: We assessed osteocalcin, C-terminal telopeptide of type I collagen, ACTH, cortisol after the dexamethasone suppression test (F-1mgDST), BclI and N363S single-nucleotide polymorphisms (SNPs) of glucocorticoid receptor, lumbar spine and femoral neck bone mineral density by dual x-ray absorptiometry, and VFx by radiography. Results: Comparedwith controls, T2Dsubjectshadincreased VFx prevalence (20 vs 34.3%, respectively; P =.031), bone mineral density (Z-scores, lumbar spine, 0.16 ± 1.28 vs 0.78 ± 1.43, P =.001; femoral neck, -0.03 ± 0.87 vs 0.32 ± 0.98, P =.008, respectively), and F-1mgDST (1.06 ± 0.42 vs 1.21 ± 0.44 ±g/dL, 29.2 ± 1.2 vs 33.3 ± 1.2 nmol/L, respectively; P =.01), and decreased osteocalcin (10.6 ± 6.4 vs 4.9±3.2 μg/mL, 10.6±6.4 vs 4.9±3.2±g/L, respectively; P