Lumbar Spine and Femoral Neck Bone Mineral Density in Adults With Type 2 Diabetes With and Without Chronic Kidney Disease
A Cross-Sectional Study
DOI:
https://doi.org/10.59667/sjoranm.v27i1.26Keywords:
Osteoporosis, Diabetes, Chronic kidney disease, Osteopenia, Bone mineral density, DEXAAbstract
Objective. To compare lumbar spine and right femoral neck bone mineral density across three groups of adults. Methods. The study included 210 participants, with 70 in each group: type 2 diabetes with chronic kidney disease, type 2 diabetes without chronic kidney disease, and nondiabetic controls. Bone mineral density was assessed with dual-energy X-ray absorptiometry. Results. Mean lumbar spine T-scores were −2.49, −1.69 and −0.75, respectively. Mean right femoral neck T-scores were −1.29, −0.84 and −0.40. The reported overall group comparisons yielded p < 0.001 for lumbar spine T-scores and p = 0.002 for right femoral neck T-scores. The right femoral neck Z-score comparison yielded p = 0.72. Conclusion. In this sample, mean T-scores were lowest in the group with type 2 diabetes and chronic kidney disease at both measured sites. The comparison describes group differences at the time of assessment.
References
1. Ranasinghe P, Jayawardena R, Gamage N, Sivanandam N, Misra A. Prevalence and trends of the diabetes epidemic in urban and rural India: A pooled systematic review and meta-analysis of 1.7 million adults. Annals of epidemiology. 2021 Jun 1;58:128-48. https://doi.org/10.1016/j.annepidem.2021.02.016 DOI: https://doi.org/10.1016/j.annepidem.2021.02.016
2. Luhar S, Timæus IM, Jones R, Cunningham S, Patel SA, Kinra S, Clarke L, Houben R. Forecasting the prevalence of overweight and obesity in India to 2040. PloS one. 2020 Feb 24;15(2):e0229438. https://doi.org/10.1371/journal.pone.0229438 DOI: https://doi.org/10.1371/journal.pone.0229438
3. Kumar AS, Sinha N. Cardiovascular disease in India: a 360 degree overview. Medical Journal Armed Forces India. 2020 Jan 1;76(1):1-3. https://doi.org/10.1016/j.mjafi.2019.12.005 DOI: https://doi.org/10.1016/j.mjafi.2019.12.005
4. Paul S, Ali A, Katare R. Molecular complexities underlying the vascular complications of diabetes mellitus–A comprehensive review. Journal of Diabetes and its Complications. 2020 Aug 1;34(8):107613. https://doi.org/10.1016/j.jdiacomp.2020.107613 DOI: https://doi.org/10.1016/j.jdiacomp.2020.107613
5. Balaji R, Duraisamy R, Kumar MP. Complications of diabetes mellitus: A review. Drug Invention Today. 2019 Jan 15;12(1). https://www.researchgate.net/publication/332569443_
6. Bai J, Gao Q, Wang C, Dai J. Diabetes mellitus and risk of low-energy fracture: a meta-analysis. Aging clinical and experimental research. 2020 Nov;32:2173-86. https://doi.org/10.1007/s40520-019-01417-x DOI: https://doi.org/10.1007/s40520-019-01417-x
7. Eller-Vainicher C, Cairoli E, Grassi G, Grassi F, Catalano A, Merlotti D, Falchetti A, Gaudio A, Chiodini I, Gennari L. Pathophysiology and management of type 2 diabetes mellitus bone fragility. Journal of Diabetes Research. 2020 May 23;2020. https://doi.org/10.1155/2020/7608964 DOI: https://doi.org/10.1155/2020/7608964
8. Ala M, Jafari RM, Dehpour AR. Diabetes mellitus and osteoporosis correlation: challenges and hopes. Current Diabetes Reviews. 2020 Nov 1;16(9):984-1001. https://doi.org/10.2174/1573399816666200324152517 DOI: https://doi.org/10.2174/1573399816666200324152517
9. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022 Apr 1;12(1):7-11. https://doi.org/10.1016/j.kisu.2021.11.003 DOI: https://doi.org/10.1016/j.kisu.2021.11.003
10. Liu J, Ren ZH, Qiang H, Wu J, Shen M, Zhang L, Lyu J. Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention. BMC public health. 2020 Dec;20:1-2. https://doi.org/10.1186/s12889-020-09502-x DOI: https://doi.org/10.1186/s12889-020-09502-x
11. Cheng HT, Xu X, Lim PS, Hung KY. Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015. Diabetes Care. 2021 Jan 1;44(1):89-97. https://doi.org/10.2337/dc20-1913 DOI: https://doi.org/10.2337/dc20-1913
12. Shetty S, John B, Mohan S, Paul TV. Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis. Archives of Osteoporosis. 2020 Dec;15:1-6. https://doi.org/10.1007/s11657-020-0688-9 DOI: https://doi.org/10.1007/s11657-020-0688-9
13. Messina C, Albano D, Gitto S, Tofanelli L, Bazzocchi A, Ulivieri FM, Guglielmi G, Sconfienza LM. Body composition with dual energy X-ray absorptiometry: from basics to new tools. Quantitative imaging in medicine and surgery. 2020 Aug;10(8):1687. https://doi.org/10.21037/qims.2020.03.02 DOI: https://doi.org/10.21037/qims.2020.03.02
14. Walker MD, Williams J, Lewis SK, Bai JC, Lebwohl B, Green PH. Measurement of forearm bone density by dual energy x-ray absorptiometry increases the prevalence of osteoporosis in men with celiac disease. Clinical Gastroenterology and Hepatology. 2020 Jan 1;18(1):99-106. https://doi.org/10.1016/j.cgh.2019.03.049 DOI: https://doi.org/10.1016/j.cgh.2019.03.049
15. Freiman JA, Chalmers TC, Smith HA, Kuebler RR. The importance of beta, the type II error, and sample size in the design and interpretation of the randomized controlled trial: survey of two sets of “negative” trials. InMedical uses of statistics 2019 May 20 (pp. 357-389). CRC Press. https://www.taylorfrancis.com/chapters/edit/10.1201/9780429187445-19/ DOI: https://doi.org/10.1201/9780429187445-19
16. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis international. 2006 Dec;17:1726-33. https://doi.org/10.1007/s00198-006-0172-4 DOI: https://doi.org/10.1007/s00198-006-0172-4
17. Adil C, Aydın T, Taşpınar Ö, Kızıltan H, Eriş AH, Hocaoglu IT, Poşul S, Kepekci M, Denizli E, Güler M. Bone mineral density evaluation of patients with type 2 diabetes mellitus. Journal of physical therapy science. 2015;27(1):179-82. https://doi.org/10.1589/jpts.27.179 DOI: https://doi.org/10.1589/jpts.27.179
18. Chen H, Li J, Wang Q. Associations between bone-alkaline phosphatase and bone mineral density in adults with and without diabetes. Medicine. 2018 Apr;97(17). https://doi.org/10.1097/MD.0000000000010432 DOI: https://doi.org/10.1097/MD.0000000000010432
19. Asokan AG, Jaganathan J, Philip R, Soman RR, Sebastian ST, Pullishery F. Evaluation of bone mineral density among type 2 diabetes mellitus patients in South Karnataka. Journal of natural science, biology, and medicine. 2017 Jan;8(1):94. https://doi.org/10.4103/0976-9668.198363 DOI: https://doi.org/10.4103/0976-9668.198363
20. Jang M, Kim H, Lea S, Oh S, Kim JS, Oh B. Effect of duration of diabetes on bone mineral density: a population study on East Asian males. BMC endocrine disorders. 2018 Dec;18:1-9. https://doi.org/10.1186/s12902-018-0290-y DOI: https://doi.org/10.1186/s12902-018-0290-y
21. Huang JF, Zheng XQ, Sun XL, Zhou X, Liu J, Li YM, Wang XY, Zhang XL, Wu AM. Association between bone mineral density and severity of chronic kidney disease. International journal of endocrinology. 2020 Oct 28;2020. https://doi.org/10.1155/2020/8852690 DOI: https://doi.org/10.1155/2020/8852690
22. Yenchek RH, Ix JH, Shlipak MG, Bauer DC, Rianon NJ, Kritchevsky SB, Harris TB, Newman AB, Cauley JA, Fried LF, Health, Aging, and Body Composition Study. Bone mineral density and fracture risk in older individuals with CKD. Clinical Journal of the American Society of Nephrology. 2012 Jul 1;7(7):1130-6. https://doi.org/10.2215/CJN.12871211 DOI: https://doi.org/10.2215/CJN.12871211
23. Gad SA, Elagrody AI. Are Diabetes Mellitus and Diabetic Nephropathy Good Predictors of Osteoporosis. The Egyptian Journal of Hospital Medicine. 2021 Jan 1;82(3):497-501. DOI: https://doi.org/10.21608/ejhm.2021.146992
24. Malmgren L, McGuigan F, Christensson A, Akesson KE. Reduced kidney function is associated with BMD, bone loss and markers of mineral homeostasis in older women: a 10-year longitudinal study. Osteoporosis International. 2017 Dec;28:3463-73. https://doi.org/10.1007/s00198-017-4221-y DOI: https://doi.org/10.1007/s00198-017-4221-y
25. Miller PD. Bone disease in CKD: a focus on osteoporosis diagnosis and management. American journal of kidney diseases. 2014 Aug 1;64(2):290-304. https://doi.org/10.1053/j.ajkd.2013.12.018 DOI: https://doi.org/10.1053/j.ajkd.2013.12.018
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The data that support the findings of this study are available from the corresponding author upon reasonable request. The data contain potentially identifiable patient information and are therefore not publicly available in accordance with Institutional review board and data protection regulations.
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