Page 63 - JCTR-11-1

Journal of Clinical and
Translational Research Osteoporosis risk factors in diabetics

1. Introduction was obtained before starting the study (reference number:
IEC/AIIMS BBSR/STS/2022-23/09). Informed written
Type 2 diabetes mellitus (T2DM) is a common metabolic consent was obtained from the patients who were recruited
disease, and its burden has been increasing with the aging into the study. A total of 203 patients above 50 years of
population. It is estimated that by the year 2025, the age and diagnosed with T2DM were recruited by the
number of diabetic cases in India will reach 69.9 million, convenient sampling for the study. The patients were
with a vast majority still undiagnosed. Among the many excluded if they had any one of the following reasons:
1
complications of T2DM, osteoporosis is also a commonly nonconsenting, nondiabetic, age below 50 years, having
diagnosed metabolic disease in the Indian population hyperthyroidism, hyperparathyroidism, connective tissue
over 50 years of age. Osteoporosis predisposes to fragility disorders, malignancy, Cushing’s syndrome, on steroid
fractures, and the development of such fractures is therapy, on anti-osteoporotic drugs, chronic kidney
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associated with high rates of morbidity and mortality, disease (CKD), or chronic infections (e.g., tuberculosis
especially in the elderly. Globally, nearly 200 million people
2
suffer from osteoporosis each year. Risk factors associated and human immunodeficiency virus [HIV]).
3
with osteoporosis include age, female sex, ethnicity, family 2.2. Assessment of BMD and diagnosis of
history of osteoporosis, smoking, Vitamin D deficiency, low osteoporosis
calcium, high caffeine intake, immobilization, increased
age at menarche, early menopause, and underweight. Measuring bone density has been the leading method for
4
The overall prevalence of osteoporosis among the the early identification of individuals at high risk of fracture.
adult population in India is 18.3%. The coexistence of Among several techniques used for measuring BMD, dual-
5
osteoporosis and T2DM is common among the elderly energy X-ray absorptiometry (DEXA) is the gold standard
population, putting this group at higher risk of bone in clinical practice for its accuracy, precision, stability, cost,
fracture. Bone turnover markers are altered in DM patients subject radiation dose and compliance, freedom to select
and may be associated with fractures. In type 1 diabetes skeletal sites, speed, and ease of scanning. In the present
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mellitus (T1DM), the low bone mineral density (BMD) is study, DEXA was used to assess the BMD at the femoral
due to low circulating levels of insulin-like growth factor neck (hip) and lumbar region (L1–L4 vertebrae). It was
1 (IGF-1) and insulin, and this usually occurs in young measured in the supine position with a Hologic Horizon
children before peak bone mass attainment. While T2DM A system (Hologic Inc., United States of America [USA]).
is common in adults who have already attained peak bone Based on T-scores obtained, according to the World Health
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mass, the effect of T2DM on BMD remains unclear, as it Organization (WHO) guidelines, with standard reference
may increase, decrease, or remain constant. Additional mean estimated for young female adults, the subjects were
7,8
investigations are desirable to explore possible risk factors classified as follows:
and predictors of osteoporosis among the elderly. (i) Normal: T-score ≥ −1 standard deviation (SD)
(ii) Low bone mass (osteopenia): T-score < −1 SD and >
To provide optimal bone health care for the −2.5 SD
growing number of patients with DM, awareness of the (iii) Osteoporosis: T-score ≤ −2.5 SD.
epidemiology, careful clinical assessment, and appropriate
prevention or treatment of skeletal diseases are pivotal. 2.3. Clinical evaluation
Due to the paucity of reports, 5,9,10 the present study was The recruited participants’ demographic profile (age and
planned to investigate the prevalence of osteoporosis and sex), anthropometric assessment (body mass index [BMI]
the associated risk factors in male and female diabetic and waist-to-hip ratio [WHR]), menstrual history (for
individuals above 50 years of age at our tertiary care female participants), duration of diabetes, and relevant
hospital.
past, personal, and medication history were recorded in
2. Methods the preapproved case study pro forma. The duration of
menopause was counted in years from the last menstrual
2.1. Study participants period as recalled by the subject.
5
Considering a population prevalence of 18% and 2.4. Biochemical analysis
assuming a sample prevalence of 25%, the calculated
sample size was 203. A cross-sectional and observational After overnight fasting, 6 mL of venous blood samples were
study was conducted in the Outpatient Department of collected from all the patients. The serum urea, creatinine,
General Medicine at All India Institute of Medical Sciences and calcium were estimated by colorimetric method and
(AIIMS), Bhubaneswar, India, between June and August HbA1C using the immunoturbidimetry method with
2023. Approval from the Institutional Ethics Committee ready-to-use reagents in the Beckman Coulter AU5800

Volume 11 Issue 1 (2025) 57 doi: 10.36922/jctr.24.00062