CONTEXT: Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community-dwelling elderly. OBJECTIVE: The objective of this study was to investigate whether type 2 DM affects bone mass, bone turnover, or prospective fracture rates in frail, elderly women living in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This study was a prospective cohort of 583 patients with type 2 DM and 1081 control (CTR) individuals above age 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams. MAIN OUTCOME MEASURES: We performed quantitative bone ultrasound measurements at the calcaneus, radius, and proximal third phalanx, measurements of quadriceps strength, and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other nonvertebral fractures over 2 yr. RESULTS: Patients with type 2 DM had significantly higher age-, weight-, and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial speed of sound (P < 0.005), and phalangeal speed of sound (P < 0.05) measurements when compared with CTRs. Mean serum PTH (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with CTRs. Important independent determinants of bone turnover in both patient groups were PTH, creatinine clearance, alanine aminotransferase, as well as glycosylated hemoglobin levels, together accounting for 30-40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in CTRs) and 3.4% (in type 2 DM) per 100 patient years; this was not significantly different for CTRs and diabetics. CONCLUSIONS: Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.
CONTEXT: Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community-dwelling elderly. OBJECTIVE: The objective of this study was to investigate whether type 2 DM affects bone mass, bone turnover, or prospective fracture rates in frail, elderly women living in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This study was a prospective cohort of 583 patients with type 2 DM and 1081 control (CTR) individuals above age 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams. MAIN OUTCOME MEASURES: We performed quantitative bone ultrasound measurements at the calcaneus, radius, and proximal third phalanx, measurements of quadriceps strength, and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other nonvertebral fractures over 2 yr. RESULTS:Patients with type 2 DM had significantly higher age-, weight-, and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial speed of sound (P < 0.005), and phalangeal speed of sound (P < 0.05) measurements when compared with CTRs. Mean serum PTH (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with CTRs. Important independent determinants of bone turnover in both patient groups were PTH, creatinine clearance, alanine aminotransferase, as well as glycosylated hemoglobin levels, together accounting for 30-40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in CTRs) and 3.4% (in type 2 DM) per 100 patient years; this was not significantly different for CTRs and diabetics. CONCLUSIONS: Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.
Authors: Joshua N Farr; Matthew T Drake; Shreyasee Amin; L Joseph Melton; Louise K McCready; Sundeep Khosla Journal: J Bone Miner Res Date: 2014-04 Impact factor: 6.741
Authors: C J Crandall; D Miller-Martinez; G A Greendale; N Binkley; T E Seeman; A S Karlamangla Journal: Osteoporos Int Date: 2011-08-03 Impact factor: 4.507
Authors: S Pilz; A Meinitzer; A Tomaschitz; K Kienreich; H Dobnig; M Schwarz; D Wagner; C Drechsler; C Piswanger-Sölkner; W März; A Fahrleitner-Pammer Journal: Osteoporos Int Date: 2012-03-17 Impact factor: 4.507
Authors: Joyce B J van Meurs; Thomas A Trikalinos; Stuart H Ralston; Susana Balcells; Maria Luisa Brandi; Kim Brixen; Douglas P Kiel; Bente L Langdahl; Paul Lips; Osten Ljunggren; Roman Lorenc; Barbara Obermayer-Pietsch; Claes Ohlsson; Ulrika Pettersson; David M Reid; Francois Rousseau; Serena Scollen; Wim Van Hul; Lidia Agueda; Kristina Akesson; Lidia I Benevolenskaya; Serge L Ferrari; Göran Hallmans; Albert Hofman; Lise Bjerre Husted; Marcin Kruk; Stephen Kaptoge; David Karasik; Magnus K Karlsson; Mattias Lorentzon; Laura Masi; Fiona E A McGuigan; Dan Mellström; Leif Mosekilde; Xavier Nogues; Huibert A P Pols; Jonathan Reeve; Wilfried Renner; Fernando Rivadeneira; Natasja M van Schoor; Kurt Weber; John P A Ioannidis; André G Uitterlinden Journal: JAMA Date: 2008-03-19 Impact factor: 56.272