Altered Bone Metabolic Markers In Type 2 Diabetes Mellitus: Impact of Glycemic Control

Objective To study the influence of glycemic control on bone minerals d biochemical markers of bone metabolism in patients with type 2 diabetes mellitus. Methods A Case-control study was conducted at Uhod Hospital, KSA from October 2003 to August 2004 to study 60 premenopausal, multipareous female patients with type 2 diabetes mellitus for >5 years, under oral anti-diabetics, with no diabetic complications. They were divided according to their glycemic control into: controlled group (n=22) and poorly controlled group (n=38) and were compared to 30 age matched healthy women. Osteocalcin (OC), urinary deoxypyridinoline (Dpd), Parathyroid hormone (PTH) were measured by chemiluminescent enzyme immunometric assay and 25 hydroxy vitamin D (25 OH-D) was measured by high performance liquid chromatography. Results In both diabetic groups, there were higher ALP (177 +/- 39.58 & 287 +/- 41.4 mg/dl) and PTH (49 +/- 9.87 & 56.25 +/- 12.3 Pg/ml) than in controls (144 +/- 22.54 mg/dl, 26.9 +/- 5.60 Pg respectively ), but lower serum calcium (8.87 +/- 03 & 8.79 +/- 07 mg/dl), and 25 OH-D (50.9 +/- 12.6, 45.4 +/- 18.9 mu g/l) and osteocalcin (4.09 +/- 1.48 & 1.89 +/- 0.24 ng/ml) than controls (9.96 +/- 1.91, 57.9 +/- 13 mu g/l, 6.5 +/- 15 ng/ml respectively), Urinary calcium and urinary Dpd were higher (270.66 +/- 41.7 & 300.56 +/- 55.67 mg/d & 10.8 +/- 4.6, 12.06 +/- 5.12 nM/mM creatinine) than in controls (244.23 +/- 513 mg/d, 62 +/- 08 nM/mM creatinine). Glycemic indices BG, HbA(1C)) showed significant positive correlation with ALP (r=0.290 & 0/94), urinary calcium =0.340 & 0.260) and Dpd (r=0.468 & 0228). Conclusion Our data give evidence of altered bone metabolic markers in both controlled and uncontrolled female patients with type 2 diabetes mellitus with more significant alterations in the uncontrolled group. This could reflect the strong impact of glycemic control on diabetic bone turnover.