25-hydroxyvitamin D levels, bone mineral density and vertebral fractures in patients with type 2 diabetes mellitus with and without metabolic syndrome

BRANCE ML; RAMÍREZ STIEBEN LA; DOBRY R; ANCA L; GONZÁLEZ A; LÓPEZ MI; BAYO S; SÁNCHEZ A; BRUN LR

Denver

Congreso; American Society for Bone and Mineral Research Meeting 2017; 2017

American Society for Bone and Mineral Research

25-hydroxyvitamin D (25OHD) has been associated withinsulin resistance, metabolic syndrome (MS) and type 2 diabetes (DM2). Inaddition, DM2 patients showed an increased risk of fracture. The aim of thisstudy was to evaluate 25OHD levels, bone mineral density (BMD) and vertebralfractures (VFx) in patients with DM2. An observational study with 209 patientswith DM2 and 173 patients as control group (CG) over 18 years from Rosario city(32º52'18''S) Argentina were carried out from January to December 2016. Exclusioncriteria: chronic renal or liver disease, cancer, autoimmune or connectivediseases, or patients treated with glucocorticoids, anticonvulsants or vitaminD. The total 25OHD (ng/ml) was performed by chemiluminescence. The BMD (g/cm2)was determined by DXA (Lunar Prodigy). VFx were assessed by Genantclassification. The results are expressed as mean±EE. Data distribution wasanalyzed using the Kolmogorov-Smirnov test and the comparison between groupswas performed with parametric and non-parametric tests as appropriate. Results:The DM2 group consisted in 117women and 92 men (60.9±0.7 years, 9.5±0.56 years of DM2 diagnosis, 75.7% with MSand 7.5±0.1% of HbA1c). The CG consisted in 152 women and 21 men with 62.6±1.2years. The DM2 group showed higher BMI (CG= 27.1±0.4, DM2= 32.5±0.4 kg/m2,p<0.0001) and higher percentage of obese and overweight patients (chi2 test,p<0.0001). BMD of postmenopausal women was significantly higher in DM2(L1-L4: GC= 0.997±0.033, DM2= 1.129±0.033; femoral neck: GC= 0.782±0.013, DM2=0.883±0.018). However the prevalence of VFx was significantly higher in DM2 (chi2test, RR: 3.09, p<0.0001). 25OHD was significantly lower in DM2 (GC=24.0±0.6, DM2= 19.5±0.8, p<0.0001) without differences between patients withand without VFx. In DM2, a higher percentage of 25OHD deficiency was found (GC=37.7%, DM2= 62.2%, p<0.0001). The 25OHD showed correlation with BMI (r=-0.28) and age (r= -0.20). The subgroup of patients with MS (n=156) showedsignificantly higher BMI and lower 25OHD (without MS= 22.0±1.4; with MS= 18.6±0.6). The triglyceride/HDL index, usedas indirect marker of insulin resistance, was significantly higher in DM2 (GC=1.5±0.1, DM2= 3.6±0.2) and correlated with HbA1c (r= 0.26) and 25OHD (r=-0.16). It is concluded that DM2 patients have lower 25OHDlevels and higher prevalence of VFx despite better BMD. The subgroup ofpatients without MS showed higher levels of 25OHD similar to the CG.