Hypogonadal men with type 2 diabetes mellitus have smaller bone size and lower bone turnover

• Published in: Bone (New York, N.Y.) N.Y.), 2017-06, Vol.99, p.14-19
• Main Authors: Colleluori, Georgia, Aguirre, Lina, Dorin, Richard, Robbins, David, Blevins, Dean, Barnouin, Yoann, Chen, Rui, Qualls, Clifford, Villareal, Dennis T, Armamento-Villareal, Reina
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bone; Bone and Bones - anatomy & histology; Bone and Bones - metabolism; Bone Density - physiology; Bone geometry; Bone Remodeling - physiology; Collagen Type I - blood; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - metabolism; Humans; Hypogonadism; Hypogonadism - blood; Hypogonadism - metabolism; Male; Middle Aged; Orthopedics; Osteocalcin - blood; Peptides - blood; Sex Hormone-Binding Globulin - metabolism; T2D; Testosterone; Testosterone - blood; Vitamin D - analogs & derivatives; Vitamin D - blood
• ISSN: 8756-3282; 1873-2763
• DOI: 10.1016/j.bone.2017.03.039

Abstract Introduction Both hypogonadism and type 2 diabetes mellitus (T2D) are associated with increased fracture risk. Emerging data support the negative effect of low testosterone on glucose metabolism, however, there is little information on the bone health of hypogonadal men with diabetes. We evaluated the bone mineral density (BMD), bone geometry and bone turnover of hypogonadal men with T2D compared to hypogonadal men without diabetes. Materials and Methods Cross-sectional study, men 40–74 years old, with average morning testosterone (done twice) of < 300 ng/dl. Areal BMD (aBMD) was measured by DXA; volumetric BMD (vBMD) and bone geometry by peripheral-quantitative-computed-tomography; serum C-telopeptide (CTX), osteocalcin, sclerostin and sex hormone-binding globulin (SHBG) by ELISA, testosterone and 25-hydroxyvitaminD (25OHD) by automated immunoassay and estradiol by liquid-chromatography/mass-spectrometry. Groups were compared by ANOVA adjusted for covariates. Results One-hundred five men, 49 with and 56 without diabetes were enrolled. Adjusted vBMD at 38% tibia was higher in diabetic than non-diabetic men (857.3 ± 69.0 vs. 828.7 ± 96.7 g/cm2, p = 0.02). Endosteal (43.9 ± 5.8 mm vs. 47.1 ± 7.8 mm, p = 0.04) and periosteal (78.4 ± 5.0 mm vs. 81.3 ± 6.5 mm, p = 0.02) circumferences and total area (491.0 ± 61.0 mm2 vs. 527.7 ± 87.2 mm2 , p = 0.02) at 38% tibia, were lower in diabetic men even after adjustments for covariates. CTX (0.25 ± 0.14 ng/ml vs. 0.40 ± 0.19 ng/ml, p < 0.001) and osteocalcin (4.8 ± 2.8 ng/ml vs. 6.8 ± 3.5 ng/ml, p = 0.006) were lower in diabetic men; there were no differences in sclerostin and 25OHD. Circulating gonadal hormones were comparable between the groups. Conclusion Among hypogonadal men, those with T2D have higher BMD, poorer bone geometry and relatively suppressed bone turnover. Studies with larger sample size are needed to verify our findings and possible even greater risk for fractures among hypogonadal diabetic men.