Review Article - (2022) Volume 13, Issue 11
The goal of the project is to create a feasible model for assessing the condition of bone turnover in diabetic patients and to assess the clinical utility of the model in detecting diabetic osteopathy. The Endocrinology Department of the Therapeutic Clinic at AM University was the site of the study from 2015 to 2017. 235 patients in all were evaluated for the study (98 with T1DM and 137 with T2DM). 89 healthy individuals served as controls. All 235 patients had their bone mineral density (BMD) assessed using dual energy X-ray absorptiometry (DXA), along with parathyrin, 25(OH) D, and serum levels of the markers of bone remodelling amino terminal propeptide of procollagen type I (P1NP) and c-terminal telopeptide of type I collagen (CTX). Our findings demonstrate that independent of age or disease duration, individuals with T2DM had lower b-CTx values and significantly greater levels of P1NP, implying less dramatic changes in bone metabolism compared to those with T1DM. Compared to 13% of patients with T2DM, osteoporosis was found in 50% of T1DM patients. When assessing the condition of bone tissue in the early stages of diabetes, bone remodelling markers can be helpful because changes in bone microarchitecture may not always be picked up by tests of bone mineral density.
Body mass index; Type 2 diabetes mellitus; Femoral neck strength; Bone mineral density; Osteoporosis
Severe metabolic problems in the body lead to issues associated to diabetes. Diabetic osteopathy, which raises the risk of fractures and causes a high level of disability and mortality, is one of the most socially significant ones [1]. According to statistics, people with diabetes have a six-times-higher incidence of femoral neck fractures than the general population. Due to inadequate insulin secretion, T1DM patients have slower bone formation and substantially faster bone resorption, which results in decreased bone mass density, poor mineralization, and altered bone microarchitecture. Patients with type 2 diabetes experience changes in the metabolism of bone tissue slightly differently. T2DM patients have a 10–30% increased fracture risk than individuals without the disease who were matched for age [2].
Fracture risk is increased in the elderly population (those over 65) due to age-related bone loss. Even after removing fall-related variables including sensorimotor deficit and neuropathy, the risk of bone fractures is still high.
The paradox of fragility fractures at T2DM is the high bone mineral density (BMD) in the majority of the already published research and, at the same time, a contrasted decline in bone micro- and microarchitecture quality. This makes it more difficult to properly screen this group of patients who are at a high risk of fractures. This study's objectives are to create a useful model for assessing the bone turnover state in people with type 1 and type 2 diabetes and to assess the model's clinical utility in detecting diabetic osteopathy [3].
The Health Research Ethics Committee at AM University approved the study, which was carried out in compliance with the guidelines of the Helsinki Declaration. Each participant provided written informed permission after being told of the study's purpose. A cross-sectional study included 98 (female: 57/male: 41) and 137 (female: 85/male: 52) T1DM and T2DM patients who had not previously received an osteoporosis diagnosis. Patients who participated in the survey ranged in age from 40 to 70 (55.8 0.7 for T1DM and 58.4 0.9 for T2DM). With a mean HbA1c of 57 0.2 for T1DM and 58 0.4% for T2DM, respectively, the average duration of diabetes was 16.6 0.6 for T1DM and 8.1 0.7 for T2DM; 42% and 88% of patients with DM had neuropathy and retinopathy, respectively [4].
Patients with acute complications of diabetes, hepatic dysfunction, renal dysfunction, and diabetic nephropathy of the 4-5 stages in the anamnesis were excluded, as were patients who have received treatment with steroids, glitazones, and type 2 sodium-glucose transporter (SGLT-2) inhibitors; received treatment for osteoporosis or have a history of fracture; and all of these conditions. The control group included 82 patients (age: 55.9 0.9; females: 48; males: 34). As controls, normoglycemic subjects who appeared healthy were chosen. The BMI of the control group was 28.7 0.4 kg/m2 [5].
Standardized methods were used to measure both height and weight. BMI was calculated as weight per square of height (kg/m2). Before 10 a.m., blood samples were taken centrifuged in heparin, frozen at 70°C, and then quickly thawed before serum biomarker and hormone analysis. An automatic electrochemiluminescence analyzer was used to measure the biochemistry panel, which included HbA1c, sodium, potassium, magnesium (Mg2+), total calcium (tCa), ionised calcium (Ca2+), phosphate (P+), creatinine, albumin, alkaline phosphatase (ALP), amino terminal propeptide of procollagen type I (PINP), and C-terminal telopeptide of type I collagen (be (COBAS C, Roche Diagnostics GmbH Mannheim, Germany). The CKD-EPI equation was used to compute glomerular filtration rate (GFR) as follows: (=141 min (SCr (smg/dl)/k, 1) a max (SCr/k, 1)1,209 0.993 age (x1.018 if female) (in ml/ min/1.73 m2). According to the manufacturer's instructions, commercially available ELISA tests of insulin, parathyroid hormone (PTH), calcitonin (CT), and vitamin D (25(OH) D) were run. The homeostasis model assessment of insulin resistance (HOMA-IR) used the following equation to calculate insulin sensitivity: (fasting insulin (mIU/ml) fasting glucose (mmol/L))/22.5 [6].
All participants had DXA for the proximal, femoral neck, and lumbar spine using a densitometer (DXA HOLOGIC, Discovery QDR 4500A, and USA). The World Health Organization uses BMD (T-score 2.5 SD), osteopenia (T-score between 1 and 2.5 SD), and normal (T-score > 1) as the criteria for diagnosing osteoporosis. The STATISTICA 10 tool was used to conduct the statistical analysis. Unless otherwise stated, data were reported as mean (M) and confidence interval (95% CI). The Mann-Whitney U test was used to examine unpaired parametric data included in the statistical analysis. To evaluate the strength of the relationship between the parameters, Spearman's rank correlation was determined [7].
Numerous variables, including diabetes, raise the risk of diseases of bone turnover. As a result, we studied biochemical markers of bone metabolism in patients of the same age who were both healthy and diabetic. Only patients with well-controlled diabetes and no late-stage complications made up the institutionalised group. The association between the Ca2+ and 25(OH) D level for T1DM (R = 0.507); for T2DM (R = 0.277 ;) indicates that there was some variation in the serum concentration of vitamin D between the three patient groups. Vitamin D acts by promoting intestinal absorption of calcium and phosphorus. As a result, vitamin D controls the equilibrium of calcium and phosphorus [8].
The ability of the kidneys to eliminate these signals, which clears the circulation and lowers GFR, is related to the connection between bone remodelling markers and renal function. For instance, a lower GFR will result in less CTX being excreted through the urine, which will raise serum levels. According to studies, there is a strong relationship between GFR and vitamin D (R = 0.346), as well as PTH and GFR in T2DM (R = 0.213). Phosphate retention, which results from a decline in renal function, aids in the development of secondary hyperparathyroidism by a number of interrelated processes [9].
The mean values of the bone resorption marker b-CTx in both DM groups were in reference intervals, but higher than in the control group, which indicates increased bone resorption in accordance with the previously reported literature. Also, the results of the analysis revealed a higher BMI in individuals with low serum b-CTx, as described previously in several other studies. A statistically negative relationship was found between HbA1c and P1NP for T1DM (R = −0.252 ;) and for T2DM (R = −0.254 ;). The negative association indicated that increases of blood glucose concentration may affect bones by altering bone formation process; hence, individuals with diabetes are at higher risk of fragility fractures [10].
Patients with both DMs exhibited a higher incidence of bone fractures in the lumbar spine T-score (64% for T1DM and 44% for T2DM; 26% for controls) and femoral neck area (41% for T1DM and 36% for T2DM; 22% for controls) according to an analysis of bone density. The probability of a bone fracture in the proximal femur region was also reduced (36% for T1DM and 31% for T2DM compared to 20% for controls). These results are in line with those of other studies, too. Patients under the age of 50, particularly men, showed the greatest severity of the lowered bone mineral content, which varied depending on the length of diabetes [11].
Our study has a number of advantages. First off, patients with T1DM and T2DM show an inverse relationship between serum electrolytes, hormone levels, and BMD in this study. The cross sectional design that was adopted in this investigation only allowed for the measurement of the investigated parameters at a single time point, placing restrictions on the study's scope. The small sample size may limit the importance of our findings, and some of the results described may be erroneous due to inadequate data access. As a result, several important statistics could not be quantified further, which could have an impact on the choice of controls. BMD was only measured once at each anatomical site, and we only collected serum samples from all the subjects once, which may have resulted in variations in some variables (BMD and bone remodelling marker levels) [12].
The findings of this investigation demonstrate that, regardless of age or length of disease, patients with T2DM exhibited lower b-CTx values and significantly greater levels of P1NP, implying less dramatic changes in bone metabolism than patients with T1DM. According to research, osteoporosis was found more commonly in T1DM patients (50%) than in T2DM patients (13%). Bone density and biochemical indicators can be used to identify skeletal metabolism problems. However, in some circumstances, such as in the early phases of T2DM, when the BMD measurement does not accurately reflect the actual tendency, bone remodelling markers may be helpful to enhance the assessment of the condition of bone tissue. When assessing the condition of bone tissue in the early stages of diabetes, bone remodelling markers can be helpful because changes in bone microarchitecture may not always be picked up by tests of bone mineral density.
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Received: 01-Nov-2022, Manuscript No. jdm-22-20455; Editor assigned: 04-Nov-2022, Pre QC No. jdm-22-20455; Reviewed: 18-Nov-2022, QC No. jdm-22-20455; Revised: 25-Nov-2022, Manuscript No. jdm-22-20455; Published: 30-Nov-2022, DOI: 10.35248/2155-6156.1000966
Copyright: © 2022 Luo M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
