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. 2015 Sep;9(9):OC08-12.
doi: 10.7860/JCDR/2015/14390.6450. Epub 2015 Sep 1.

Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes

Pratheesh George Mathen  1 , Molly Mary Thabah  2 , Bobby Zachariah  3 , Ashok Kumar Das  4
Affiliations

Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes

Pratheesh George Mathen et al. J Clin Diagn Res. 2015 Sep.

Abstract

Background: With prevalence of diabetes in India reaching epidemic proportions and increase in the population of geriatric age group and risks of falls, it is important to understand the effect that diabetes has on bone health.

Aim: The objective was to assess bone mineral density (BMD) of patients with type 2 diabetes mellitus (T2DM) and to study factors contributing to BMD in patients with T2DM.

Materials and methods: This was a prospective cross-sectional study on 150 patients with T2DM (diagnosed at age > 30 years) and an equal number (n=150) of age and sex matched healthy controls from September 2012 to July 2014 at a tertiary care center located in Southern India. BMD was measured at the femoral neck and lumbar spine (L2-L4) by dual energy absorptiometry (DXA) in cases and controls. Serum total calcium, phosphorus and alkaline phosphatase (ALP) and 25-OH- vitamin D3 was measured in patient group.

Results: Mean age (SD) was 51.29 (±8.05) and 51 (±8.3) years in cases and controls, respectively. The femoral neck and lumbar spine BMD was significantly lower in T2DM cases compared to controls. Also the femoral neck and lumbar spine T-score was significantly lower in T2DM cases compared to controls. Femoral neck BMD among male patients with T2DM was significantly lower compared to controls (men). Among women, BMD at femoral neck as well as lumbar spine was significantly lower in cases when compared to controls. Ninety six out of 150 (64%) T2DM cases had Vitamin D values <20 ng/mL. There was weak negative correlation between age of patient, duration of diabetes and HbA1C with femoral neck BMD. There was weak negative correlation between HbA1C and lumbar spine BMD.

Conclusion: Indian subjects with type 2 diabetes have significantly lower BMD at both femoral neck and lumbar spine compared to age and sex matched healthy controls. We conclude that osteopenia and osteoporosis are overlooked complications of diabetes. Longitudinal studies are needed to see for actual incidence of fractures among this high risk group.

Keywords: BMD; Fractures; Osteoporosis; Vitamin D deficiency.

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Figures

[Table/Fig-6]:
[Table/Fig-6]:
(a) Correlation between age of patient and BMD at femoral neck. (b) Correlation between duration of diabetes and BMD at femoral neck. (c) Correlation between BMI and BMD at femoral neck. (d) Correlation between HbA1c and BMD at femoral neck. Correlation between the age of patient and BMD at hip (femoral neck) (panel A); duration of diabetes and BMD at the hip (femoral neck) (panel B); BMI and BMD at hip (femoral neck) (panel C); mean HbA1c and BMD at hip (femoral neck). In the figure the BMD measurements at hip (femoral neck) were plotted against the age of patient (A), duration of diabetes (B), mean BMI (C) and mean HbA1c levels (D). The straight line reflects the regression and r mean correlation coefficients and dotted lines reflect the confidence intervals for each correlation
See this image and copyright information in PMC

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