For men with type 2 diabetes mellitus (T2DM), an A1c of at least 7% appears to be the threshold for lower bone turnover, regardless of which drugs are used. This is evident from research recently presented at the Endocrine Society’s virtual ENDO 2021 conference, March 20-23, 2021.
Participants were recruited from 2 clinical trials in 2 separate Veteran Affairs health centers. This study included 217 men aged 35 to 65 years (mean age 55 years) with an average BMI of 36.15 kg / m (standard deviation) [SD]6.44) and mean A1c of 6.1% (SD 1.5). In this cohort, 32.7% of participants (n = 71) were previously diagnosed with T2DM.
High performance liquid chromatography was used to measure A1c; Liquid chromatography / mass spectrometry (LC / MS) was used to measure estradiol and testosterone; An enzyme-linked immunosorbent assay was used to measure sclerostic and bone turnover markers, including osteocalcin and C-telopeptide of type 1 collagen (CTx); and dual energy X-ray absorptiometry was used to determine bone mineral density.
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A1c scores were used to classify participants into 4 categories (Group 1, <6%; group 2, 6.1%-6.5%; group 3, 6%-6.7%; group 4, >7%). Analysis of variance was used to compare the various A1c categories and simple regression analysis was used to assess correlations.
The authors of the study found significant negative correlations between A1c and osteocalcin (Pearson correlation coefficient) [r]-0.32; P <0.001) and CTx (r, -0.32; P <0.001). The participants in group 4 showed lower bone turnover markers compared to groups 1, 2 and 3 (group 4, 4.04 ng / ml) [SD, 2.64];; Group 1, 6.53 ng / ml [SD, 3.18];; Group 2, 5.99 ng / ml [SD, 3.16];; Group 3, 6.09 ng / ml [SD, 3.16];; P = 0.002) and lower CTx (group 4, 0.19 ng / ml [SD, 0.12];; Group 1, 0.34 ng / ml [SD, 0.17];; Group 2, 0.32 ng / ml [SD, 0.18];; Group 3, 0.28 ng / ml [SD, 0.14];; P = 0.0002).
All A1c categories showed comparable levels of sclerostin. Participants with T2DM had lower osteocalcin than participants with A1c of 7% or less (3.95 ng / ml) [SD, 2.68] vs 6.34 ng / ml [SD, 2.77];; P = 0.007) and lower CTx (0.18 ng / ml) [SD, 0.13] vs 0.31 ng / ml [SD, 0.15];; P <0.001). After adjusting for drugs, this correlation retained statistical significance (P = 0.003). The density of surface bone minerals did not vary significantly between men with T2DM compared to other men in the study after adjusting for basic weight, age and testosterone.
The study’s authors concluded that men with T2DM with an A1c score of 7% or more had decreased bone turnover regardless of drug use.
reference
Joad SS, Gregori G., Russo V. et al. Hemoglobin A1c of 7% is the threshold for bone disorders in men with type 2 diabetes mellitus. Presented at: ENDO 2021; 20.-23. March 2021. Meeting P11.
This article originally appeared on Endocrinology Advisor
