Association Between Serum Levels of Bone Turnover Markers and Bone Mineral Density in Men and Women with Type 2 Diabetes Mellitus

Background: In patients with type 2 diabetes mellitus (T2DM), higher risks of impaired bone metabolism are widely reported. To evaluate bone metabolism, bone mineral density (BMD) and bone turnover levels should be included. In this article, we analyzed the relationship between them in T2DM.

Methods: We conducted a hospital-based cross-sectional study enrolling 1499 patients hospitalized for T2DM between October 2009 and January 2013. Multivariate linear regression models were used to identify the relationship between bone turnover markers (BTMs) and BMD levels. A two-sided P-value < .05 was considered statistically significant.

Results: After adjusting for confounding factors, osteocalcin (OC) showed a negative relationship with total lumbar, femur neck, and total hip BMD in men and women. N-terminal propeptides of type I collagen (P1NP) and alkaline phosphatase (ALP) showed a negative association with BMD at three sites in men and total lumbar BMD in women, whereas in the femur neck and total hip in women, the relationship was only found for P1NP with total hip. For β-C-terminal telopeptides of type I collagen (β-CTX), a negative relationship was also found in all three sites for BMD in men and total lumbar BMD in women, whereas β-CTX was not associated in the femoral neck and total hip in women.

Conclusion: In patients with T2DM, serum levels of OC, P1NP, β-CTX, and ALP were negatively correlated with BMD levels in men in three sites and with total lumbar BMD in women. The relationship varied in femur neck and total hip BMD in women.