Condition of bone tissue in postmenopausal women with type 2 diabetes mellitus of Buryat population

BACKGROUND: In most countries, there is a rapid increase in the population of patients with type 2 Diabetes Mellitus (DM). Bone changes in postmenopausal women with type 2 DM are associated with increased bone mineral density (BMD). The study of metabolic processes in bone tissue in comorbid pathology in different ethnic groups is continuing.

AIMS: To study the concentration of markers of bone remodeling and indicators of BMD in postmenopausal women with type 2 DM of the Buryat population.

MATERIALS AND METHODS: Thirty-nine postmenopausal women with type 2 DM (22 – Russian population and 17 – Buryat population) were examined. The comparison group consisted of 42 postmenopausal women (21 – Russian population and 21 - Buryat population). The study of BMD in the lumbar spine (L1-L4), the femoral neck (Neck), and the proximal femur (Total hip) was performed using dual-energy X-ray absorptiometry. Parameters of osteocalcin (OC), type 1 N-terminal procollagen propeptide (P1NP), C-terminal telopeptides of type I collagen (β-Cross laps), 25(OH) vitamin D and ionized calcium were evaluated.

RESULTS: The presented study revealed a simultaneous increase in osteosynthesis: ОС (p=0.048) and P1NP (p=0.016) and in the bone resorption marker β-Cross laps (p=0.020) accompanied by the absence of changes in BMD in women with type 2 DM in the postmenopausal period of the Buryat population relative to women with type 2 DM in the postmenopausal state of the Russian population. A decrease in osteosynthesis parameters (ОC, p=0.021; P1NP, p=0.029) with an increase in BMD L1-L4 (p=0.024) and BMD Total hip (p=0.039) in postmenopausal women with type 2 DM of the Buryat population was found relative to the women of the Buryat population in comparison group.

CONCLUSIONS: The state of bone tissue in postmenopausal women with type 2 DM of the Buryat population is characterized by the activation of bone remodeling processes.

diabetes mellitus, type 2, bone remodeling, ethnicity

1. Leslie WD, Rubin MR, Schwartz AV, et al. Type 2 diabetes and bone. J Bone Miner Res. 2012;27(11):2231−2237. doi: https://doi.org/10.1002/jbmr.1759

2. Ялочкина Т.О., Белая Ж.Е., Рожинская Л.Я., и др. Переломы костей при сахарном диабете 2 типа: распространенность и факторы риска // Сахарный диабет. — 2016. — Т. 19. — №5. — C. 359−365. [Yalochkina TO, Belaya JE, Rozhinskaya LY, et al. Bone fractures in patients with type 2 diabetes mellitus: prevalence and risk factors. Diabetes mellitus. 2016;19(5):359−365. (In Russ.)] doi: https://doi.org/10.14341/dm7796

3. Дедов И.И., Шестакова М.В., Викулова О.К., и др. Сахарный диабет в Российской Федерации: распространенность, заболеваемость, смертность, параметры углеводного обмена и структура сахароснижающей терапии по данным Федерального регистра сахарного диабета, статус 2017 г. // Сахарный диабет. — 2018. — Т. 21. — №3. — С. 144−159. [Dedov II, Shestakova MV, Vikulova OK, et al. Diabetes mellitus in Russian Federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of hypoglycaemic therapy according to the Federal Diabetes Register, status 2017. Diabetes Mellitus. 2018;21(3):144−159. (In Russ.)] doi: https://doi.org/10.14341/DM9686

4. Boonen S, Body J, Boutsen Y, et al. Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int. 2005;16(3):239−254. doi: 10.1007/s00198-004-1812-1

5. Starup-Linde J, Lykkeboe S, Gregersen S, et al. Differences in biochemical bone markers by diabetes type and the impact of glucose. Bone. 2016;83:149−155. doi: https://doi.org/10.1016/j.bone.2015.11.004

6. Jiajue R, Jiang Y, Wang O, et al. Suppressed bone turnover was associated with increased osteoporotic fracture risks in non-obese postmenopausal Chinese women with type 2 diabetes mellitus. Osteoporos Int. 2014;25(8):1999−2005. doi: https://doi.org/10.1007/s00198-014-2714-5

7. Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes – a meta-analysis. Osteoporos Int. 2006;18(4):427−444. doi: https://doi.org/10.1007/s00198-006-0253-4

8. Бардымова Т.П., Мистяков М.В., Сеурко О.В. Маркеры костного метаболизма у женщин в постменопаузальном периоде с сахарным диабетом 2-го типа // Acta Biomedica Scientifica. — 2017. — Т. 2. — №1. — С. 16−18. [Bardymova TP, Mistyakov MV, Seurko OV. Metabolism. Acta Biomedica Scientifica. 2017;2(1):16−18. (In Russ.)]

9. Van Daele PL, Stolk RP, Burger H, et al. Bone density in non-insulin-dependent diabetes mellitus: the Rotterdam study. Ann Intern Med. 1995;22(6):409−414. doi: https://doi.org/10.7326/0003-4819-122-6-199503150-00002

10. Lecka-Czernik B. Diabetes, bone and glucose-lowering agents: basic biology. Diabetologia. 2017;60(7):1163−1169. doi: 10.1007/s00125-017-4269-4

11. Ferrari S, Abrahamsen B, Napoli N, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int. 2018;29(12):2585–2596. doi: https://doi.org/10.1007/s00198-018-4650-2

12. Jackuliak P, Payer J. Corrigendum to "Osteoporosis, Fractures, and Diabetes". Int J Endocrinol. 2017;2017:2846080. doi: https://doi.org/10.1155/2017/2846080

13. Brandi ML. Microarchitecture, the key to bone quality. Rheumatology. 2009;48(Suppl 4):iv3−8. doi: https://doi.org/10.1093/rheumatology/kep273

14. Ulivieri FM, Silva BC, Sardanelli F, et al. Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine. 2014;47(2):435−448. doi: https://doi.org/10.1007/s12020-014-0280-4

15. Link TM, Majumdar S. Current diagnostic techniques in the evaluation of bone architecture. Curr Osteoporos Rep. 2004;2(2):47−52. doi: https://doi.org/10.1007/s11914-004-0003-5

16. Chen H, Li X, Yue R, et al. The effects of diabetes mellitus and diabetic nephropathy on bone and mineral metabolism in T2DM patients. Diabetes Res Clin Pract. 2013;100(2):272−276. doi: https://doi.org/10.1016/j.diabres.2013.03.0077

17. Климонтов В.В., Фазуллина О.Н., Лыков А.П., и др. Взаимосвязь маркеров ремоделирования костной ткани с минеральной плотностью костей у женщин с сахарным диабетом 2 типа, находящихся в постменопаузе // Сахарный диабет. — 2016. — Т. 19. — №5. — С. 375−382. [Klimontov VV, Fazullina ON, Lykov AP, et al. The relationships between bone turnover markers and bone mineral density in postmenopausal type 2 diabetic women. Diabetes mellitus. 2016;19(5):375−382. (In Russ.)] doi: https://doi.org/10.14341/DM8008

18. Hygum K, Starup-Linde J, Harslof T, et al. Mechanisms in endocrinology: Diabetes mellitus, a state of low bone turnover – a systematic review and meta-analysis. Eur J Endocrinol. 2017;176(3):R137−157. doi: https://doi.org/10.1530/EJE-16-0652

19. Manolagas SC, Almeida M. Gone with the Wnts: beta-catenin, T-cell factor, forkhead box O, and oxidative stress in age dependent diseases of bone, lipid, and glucose metabolism. Mol Endocrinol. 2007;21(11):2605−2614. doi: https://doi.org/10.1210/me.2007-0259

20. Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007. Available from: https://www.ncbi.nlm.nih.gov/books/NBK38410/

21. Пигарова Е.А., Рожинская Л.Я., Белая Ж.Е., и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике, лечению и профилактике дефицита витамина D у взрослых // Проблемы эндокринологии. — 2016. — Т. 62. — №4. — С. 60−84. [Pigarova EA, RozhinskayaLYa, Belaya ZE, et al. Russian Association of endocrinologists recommendations for diagnosis, treatment and prevention of vitamin D deficiency in adults. Problems of Endocrinology. 2016;62(4):60−84. (In Russ.)] doi: https://doi.org/10.14341/probl201662460-84

22. Herrick KA, Storandt RJ, Afful J, et al. Vitamin D status in the United States, 2011–2014. Am J Clin Nutr. 2019;110(1):150–157. doi: https://doi.org/10.1093/ajcn/nqz037

23. Jorde R, Stunes AK, Kubiak J. Effects of vitamin D supplementation on bone turnover markers and other bone-related substances in subjects with vitamin D deficiency. Bone. 2019;124:7−13. doi: https://doi.org/10.1016/j.bone.2019.04.002