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The relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex

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Abstract

Summary

It is unknown whether a relationship exists between bone mineral density (BMD) and atherosclerosis with or without vascular calcification. In our study, a negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification and males.

Introduction

Atherosclerosis is considered associated with low bone mineral density (BMD). However, most previous studies focus on patients with arterial atherosclerosis with vascular calcification. It is still unknown whether a relationship exists between atherosclerosis and BMD in patients without calcification. It is also unknown if sex plays a role in this relationship.

Methods

We performed a retrospective cross-sectional study, which included 1459 type 2 diabetes mellitus (T2DM) patients (648 males ≥ 50 years old, and 811 postmenopausal females). They were assigned to three groups: group 1 (patients without carotid plaques and without carotid calcification), group 2 (patients with carotid plaques but without carotid calcification), and group 3 (patients with carotid plaques and with carotid calcification). Clinical characteristics and BMD were compared. The relationship between atherosclerosis and BMD was determined by binary logistic regression analysis. Statistical analysis was performed using SPSS 25.0.

Results

Significant differences were only observed in women. The percentage of osteoporosis was higher in group 3 (43.64%) than in groups 1 (34.82%) and 2 (32.14%) (P = 0.016). Low BMD was found in the lumbar (P = 0.032), hip (P < 0.001), and femoral neck (P < 0.001). The odds ratio for osteoporosis increased significantly in a score-dependent manner in postmenopausal female patients with calcified atherosclerosis, but not in uncalcified patients. In men, no differences or relationships were identified.

Conclusion

A negative correlation between carotid atherosclerosis and BMD was found in female T2DM patients with vascular calcification, but not in those without calcification. A similar relationship was not observed in male patients with or without calcification. Thus, the relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the need to protect patients’ privacy but are available from the corresponding author upon reasonable request.

Abbreviations

T2DM:

type 2 diabetes mellitus

BMD:

bone mineral density

FPG:

fasting plasma glucose

OGTT:

oral glucose tolerance test

BMI, kg/m2 :

body mass index

HbA1c:

hemoglobin A1c

HPLC:

high-performance liquid chromatography

CV:

coefficient of variation

SCr:

serum creatinine

ALT:

alanine aminotransferase

TC:

total cholesterol

TG:

triglyceride

HDL:

high-density lipoprotein

ELISA:

enzyme-linked immunosorbent assay

β-CTX:

C-terminal telopeptide fragments of type-I collagen

RIA:

radioimmunoassay

CCAs:

carotid arteries

CBs:

carotid bifurcations

ICAs:

internal carotid arteries

DEXA:

dual energy x-ray absorptiometry

MAP:

mean arterial pressure

ORs:

odds ratios

CI:

confidence intervals

CAC:

coronary artery calcium

ACR:

albumin-creatinine ratio

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Funding

This study was supported by the National Key R&D Program of China (No. 2018YFC1314100), National Natural Science Foundation of China (NSFC 81500650), the “Climbing” Program of Shanghai Tenth People’s Hospital of Tongji University (2018SYPDRC049), and the Fundamental Research Funds for the Central Universities (22120180378).

Author information

Author notes

  1. R. Cui, S. Q. Sun and N. Zhong contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

    R. Cui, M. X. Xu, S. Qu & H. Sheng

  2. Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Nanjing Medical University, Nanjing, China

    S. Q. Sun & H. Sheng

  3. Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    N. Zhong

  4. Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

    H. D. Cai

  5. Institute for Advancing Translational Medicine in Bone and Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Kowloon, Hong Kong, China

    G. Zhang

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Corresponding author

Correspondence to H. Sheng.

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This study was approved by the ethics committees of Shanghai Tenth People’s Hospital, Tongji University School of Medicine, and the requirement of informed consent was waived owing to the retrospective nature of the study.

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Cui, R., Sun, S.Q., Zhong, N. et al. The relationship between atherosclerosis and bone mineral density in patients with type 2 diabetes depends on vascular calcifications and sex. Osteoporos Int 31, 1135–1143 (2020). https://doi.org/10.1007/s00198-020-05374-4

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