Evaluation of osteoporosis and the risk of secondary fractures in postmenopausal 55- 60 years old patients with type-2 diabetes mellitus

Abstract

Postmenapozal Tip-2 diyabetes mellitus’lu hastalarda osteoporoza bağlı kırık riskinin ve kemik Turnoveri’nin değerlendirilmesi

Abstract

Tip 2 DM hastalarda KMD değerlerinden bağımsız olarak kırık riskinde artış olduğunu gösteren meta analizler mevcuttur. Diyabette kemik frajilitesindeki artış pentosidin ile ilişkilendirilmiştir. Çalışmamızda postmenopozal Tip 2 DM hastalarda kontrol grubuna göre diyabete bağlı olarak artmış kırık riskini ortaya koymak için WHO FRAX ölçeğini kullanarak hesapladığımız kırık riski yüzdesi ile kemik turnover belirteçleri, sclerostin ve pentosidin düzeylerinin ilişkisini göstermeyi planladık. Çalışmaya 55-65 yaş arası 80 postmenopozal kadın alındı. 50 kişi Tip 2 DM grubuna ve 30 kişi (DM olmayan) kontrol grubuna alındı. Çalışmaya sekonder osteoporoz nedenlerine sahip hastalar alınmadı. Diyabetik ve kontrol grubu arasında kırık riski yüzdeleri ve kemik turnover belirteçleri, pentosidin, sclerostin düzeyleri arasında anlamlı fark saptanmadı. Ayrıca kırık riski yüzdesi, KMD değerleri ile serumda bakılan belirteçler arasında korelasyon saptanmadı. Diyabetik hastalarda osteoporoza bağlı kırık riskini değerlendirmede KMD yetersiz olup, kandaki belirteçlerden faydalanılması ve FRAX a entegre edilebilmesi için yeni çalışmalara ihtiyaç vardır. There are some meta analysis about high fracture risk in type 2 DM group, independent of high BMD values. Fracture risk in DM; related with Pentosidine. In this study we aimed to determine whether there is a relation between bone turnover markers, pentosidin, sclerostin and increased fracture risk, calculated with WHO FRAX algoritm. In totaly, 80 postmenupausal women between ages 55-65 were included to this study. 50 patients with type 2 DM for DM group and 30 patients choosed for control group. Patients who have seconder osteoporosis were excluded. As a result of study there was no significant difference between with diabetics and control group as following parameters: Bone turnover markers, pentosidin and sclerostin levels and fracture risk percentages. Morover, among the markers assesed by fracture risk persentages no significant correlation determined.

Keywords

• Osteoporoz
• Tip 2 DM de fraktür riski
• pentosidin
• sclerostin

References

1. 1. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone. 2008;42(3):467-75.
2. 2. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Journal of the American Geriatrics Society. 2001;49(5):664-72.
3. 3. Ertungealp E, Seyisoglu H, Erel CT, Senturk LM, Gezer A. Changes in bone mineral density with age, menopausal status and body mass index in Turkish women. Climacteric : the journal of the International Menopause Society. 1999;2(1):45-51.
4. 4. Melton LJ, 3rd. How many women have osteoporosis now? Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1995;10(2):175-7.
5. 5. Kanis JA, Harvey NC, Johansson H, Oden A, Leslie WD, McCloskey EV. FRAX and fracture prediction without bone mineral density. Climacteric : the journal of the International Menopause Society. 2015:1-8.
6. 6. Schwartz AV, Vittinghoff E, Bauer DC et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. Jama. 2011;305(21):2184-92.
7. 7. Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J. The Use of Biochemical Markers of Bone Turnover in Osteoporosis. Osteoporosis International. 2000;11(6):S2-S17.
8. 8. Dreyer P, Vieira JG. Bone turnover assessment: a good surrogate marker? Arquivos brasileiros de endocrinologia e metabologia. 2010;54(2):99-105.

9. 9. Brownlee M. Advanced protein glycosylation in diabetes and aging. Annual review of medicine. 1995;46:223-34.
10. 10. Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. The New England journal of medicine. 1988;318(20):1315-21.
11. 11. Shiraki M, Kuroda T, Shiraki Y, Tanaka S, Higuchi T, Saito M. Urinary pentosidine and plasma homocysteine levels at baseline predict future fractures in osteoporosis patients under bisphosphonate treatment. Journal of bone and mineral metabolism. 2011;29(1):62-70.
12. 12. Van Bezooijen RL, Roelen BA, Visser A et al. Sclerostin is an osteocyte-expressed negative regulator of bone formation, but not a classical BMP antagonist. The Journal of experimental medicine. 2004;199(6):805-14.
13. 13. Winkler DG, Sutherland MK, Geoghegan JC et al. Osteocyte control of bone formation via sclerostin, a novel BMP antagonist. The EMBO journal. 2003;22(23):6267-76.
14. 14. Hens JR, Wilson KM, Dann P, Chen X, Horowitz MC, Wysolmerski JJ. TOPGAL mice show that the canonical Wnt signaling pathway is active during bone development and growth and is activated by mechanical loading in vitro. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2005;20(7):1103-13.
15. 15. Van Lierop AH, Witteveen JE, Hamdy NA, Papapoulos SE. Patients with primary hyperparathyroidism have lower circulating sclerostin levels than euparathyroid controls. European journal of endocrinology / European Federation of Endocrine Societies. 2010;163(5):833-7.
16. 16. Ziegler R. Diabetes mellitus and bone metabolism. Horm Metab Res Suppl. 1992;26:90-4.
17. 17. Sahin G, Bagis S, Cimen OB, Ozisik S, Guler H, Erdogan C. Lumbar and femoral bone mineral density in type 2 Turkish diabetic patients. Acta medica (Hradec Kralove) / Universitas Carolina, Facultas Medica Hradec Kralove. 2001;44(4):141-3.
18. 18. Weinstock RS, Goland RS, Shane E, Clemens TL, Lindsay R, Bilezikian JP. Bone mineral density in women with type II diabetes mellitus. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1989;4(1):97-101.
19. 19. Yamaguchi T, Sugimoto T. Bone metabolism and fracture risk in type 2 diabetes mellitus. BoneKEy Rep. 2012;1(2).
20. 20. Schwartz AV, Vittinghoff E, Bauer DC et al. Association of BMD and FRAX Score with Risk of Fracture in Older Adults with Type 2 Diabetes. Jama. 2011;305(21):2184-92.
21. 21. Sahota O, Masud T, San P, Hosking DJ. Vitamin D insufficiency increases bone turnover markers and enhances bone loss at the hip in patients with established vertebral osteoporosis. Clinical endocrinology. 1999;51(2):217-21.
22. 22. Perez-Diaz I, Sebastian-Barajas G, Hernandez-Flores ZG, Rivera-Moscoso R, Osorio-Landa HK, Flores-Rebollar A. The impact of vitamin D levels on glycemic control and bone mineral density in postmenopausal women with type 2 diabetes. Journal of endocrinological investigation. 2015.
23. 23. Brown JP, Albert C, Nassar BA et al. Bone turnover markers in the management of postmenopausal osteoporosis. Clinical Biochemistry. 2009;42(10–11):929-42.
24. 24. Garnero P, Hausherr E, Chapuy MC et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1996;11(10):1531-8.
25. 25. Parfitt AM, Simon LS, Villanueva AR, Krane SM. Procollagen type I carboxy-terminal extension peptide in serum as a marker of collagen biosynthesis in bone. Correlation with Iliac bone formation rates and comparison with total alkaline phosphatase. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1987;2(5):427-36.
26. 26. Kraenzlin M, Seibel M. Measurement of biochemical markers of bone resorption. Dynamics in bone and cartilage metabolism. 1999;2:541-64.
27. 27. Yamamoto M, Yamaguchi T, Yamauchi M, Yano S, Sugimoto T. Serum Pentosidine Levels Are Positively Associated with the Presence of Vertebral Fractures in Postmenopausal Women with Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2008;93(3):1013-9.
28. 28. Schwartz AV, Garnero P, Hillier TA et al. Pentosidine and Increased Fracture Risk in Older Adults with Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2009;94(7):2380-6.
29. 29. Saito M, Fujii K, Soshi S, Tanaka T. Reductions in degree of mineralization and enzymatic collagen cross-links and increases in glycation-induced pentosidine in the femoral neck cortex in cases of femoral neck fracture. Osteoporosis International. 2006;17(7):986-95.
30. 30. Lapolla A, Reitano R, Baccarin L, Sartore G, Plebani M, Fedele D. Pentosidine plasma levels and relation with metabolic control in diabetic patients. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2005;37(4):252-6.
31. 31. Gennari L, Merlotti D, Valenti R et al. Circulating Sclerostin Levels and Bone Turnover in Type 1 and Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2012;97(5):1737-44.
32. 32. García-Martín A, Rozas-Moreno P, Reyes-García R et al. Circulating Levels of Sclerostin Are Increased in Patients with Type 2 Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism. 2012;97(1):234-41.
33. 33. Ardawi M-SM, Akhbar DH, AlShaikh A et al. Increased serum sclerostin and decreased serum IGF-1 are associated with vertebral fractures among postmenopausal women with type-2 diabetes. Bone. 2013;56(2):355-62.
34. 34. Yamamoto M, Yamauchi M, Sugimoto T. Elevated Sclerostin Levels Are Associated With Vertebral Fractures in Patients With Type 2 Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism. 2013;98(10):4030-7.
35. 35. Garnero P, Sornay-Rendu E, Munoz F, Borel O, Chapurlat RD. Association of serum sclerostin with bone mineral density, bone turnover, steroid and parathyroid hormones, and fracture risk in postmenopausal women: the OFELY study. Osteoporosis International. 2013;24(2):489-94.