Osteoporosis among Diabetic Male Patients in Babylon

Abstract

Background: Diabetes mellitus and osteoporosis are chronic metabolic diseases with an elevated and growing incidence all over the world. Diabetes mellitus is a risk factor for osteoporotic fractures

Objectives

1-To evaluate the relationship between diabetes and male osteoporosis

2-To differentiate the risk of both type I and type II diabetes on bone mineral density

3-To study other risk factors of osteoporosis in the diabetic patients

Patients and Methods: This study was conducted on conveniently selected eighty diabetic male patients in Merjan teaching hospital from the diabetic consultation unit who were diagnosed by a specialist according to the ADA criteria for diagnosis of diabetes (20 with type I diabetes and  the other 60 with type II diabetes) their ages ranged from 12–79 years with a mean of age (50.21± 15.94 years), BMI (28.36±5.35) , mean of duration of diabetes (9.25± 7.31) , age of onset of diabetes (40.95± 16.08) and HbA1c (10.03± 2.77).

The control group consisted of  80 males apparently healthy age and gender matched population-based volunteers their ages ranged from 12-73 years , their mean age  was (49.22± 15.28 years) , BMI (29.51± 4.77 kg/m2) was evaluated by a specialist and recruited for the study. Women and patients with concomitant diseases or treatments known to affect bone metabolism were excluded from the study. All of the patients and controls underwent a case control study for assessment of bone mineral density (BMD) at lumbar spines in the region L1–4 in the postero-anterior (PA) projection and/or hip area using Dual energy X-ray Absorptiometry

Results: The study showed a significant difference in the mean of T or Z-scores between the diabetic patients and controls (P<0.001) .The diabetic patient was at 34 times increased risk of having osteopenia (P=0.001) and 8 times increased risk of having osteoporosis (P=0.007) than the healthy person. There was a significant difference in BMD level with the type of diabetes; type I was over-represented type II DM in its negative effect on BMD (P<0.001), duration of DM 5-10 years and more (P=0.005), age of onset of diabetes (below 40 years) P=0.044 , HbA1c level (≥ 6.5%) P=0.01, with no significant effect of type of treatment used. A significant effect was found in the mean of T or Z-scores between the type I diabetic patients and controls (P<0.001), and between type II diabetic patients and the controls (P<0.001).Type I diabetic patients were 33 more times increased risk of developing osteopenia (P=0.004) and osteoporosis(P<0.001) and type II diabetic patients were at 34 times increased risk of developing osteopenia (P=0.001) and 4 times increased risk of developing  osteoporosis(P=0.115) when compared with the healthy persons . There was a significant effect of physical inactivity (P=0.03), personal history of fracture (P<0.001), low BMI (P=0.006) on BMD level with no significant effect of advanced age, family history of fracture or osteoporosis, smoking, waist to hip ratio

Conclusions: The study confirms a significant effect of diabetes on BMD level .There is a significant effect of type I DM, early age of onset of diabetes, prolonged duration of diabetes, poor glycemic control on BMD level with no significant effect of type of treatment used in the treatment of diabetes on BMD level. The study also showed a significant difference between the mean of T or Z-scores of type I and type II diabetic patients as compared with the control group separately. Patients with type I and those with type II DM had an increased risk of low BMD level as compared with the healthy control group .The study showed a significant effect of physical inactivity, personal history of fracture, low BMI on BMD level in diabetic patients with no significant effect of advanced age, family history of osteoporosis or fracture, smoking or WHR on BMD

Keywords: Diabetes mellitus, osteoporosis, bone mineral density, Dual energy X-ray Absorptiometry