The Prevalence and Risk Factors of Osteoporosis among a Saudi Female Diabetic Population
Keywords:osteoporosis, osteopenia, Saudi women, diabetes mellitus
AIM: This study aimed to assess the prevalence and determinants of osteoporosis [lumbar spine (LS) and femoral neck (FN)] among patients with type 2 diabetes at King Salman Hospital.
MATERIALS AND METHODS: One hundred seventy patients with type 2 diabetes were enrolled in this cross-sectional study in the period from the 1st of January until the 1st of July 2015. Patient selection was based on self-report of the previous diagnosis by a physician, being on an antidiabetic agent, or a fasting glucose of 126 mg/dl as per the American Diabetes Association criteria. A dual energy X-ray absorptiometry scan with the bone mineral density (BMD) categorization based on the WHO cut of levels of T-scores and determination of vitamin D levels were performed. A detailed questionnaire was used to collect demographic data.
RESULTS: Out of 170 participants, 50 (29.4%) were diagnosed as having osteoporosis, while 68 (40%) were diagnosed with osteopenia. Age was determined as a risk factor for a decreased BMD in patients with osteopenia (odds ratio (OR) = 1.1, 95% confidence interval (CI) = (1.0-1.1), p = 0.039) and osteoporosis (OR = 1.1, CI = 1.0-1.2, p < 0.001). Similarly, oral hypoglycemic agents (OHA) increased the risk of decreased BMD in osteopenia (OR = 2.6; CI = 1.0-6.7; p = 0.023) as well as osteoporosis, (OR = 3.8; CI = 1.3-10.9; p = 0.013), while vitamin D deficiency increased the risk of osteopenia OR = 3.0; CI = 1.2-7.2; p = 0.012). Increased BMI decreased the risk of both osteopenia and osteoporosis (OR = 0.9; CI = 0.9-0.99; p = 0.031 vs. OR = 0.9; CI = 0.80-0.95; p = 0.003).
CONCLUSION: Advanced age, OHA and vitamin D deficiency are determinants of decreased BMD in Saudi women with type 2 diabetes, while an increased BMI protects against low BMD.
Plum Analytics Artifact Widget Block
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14. https://doi.org/10.1016/j.diabres.2009.10.007 PMid:19896746
Alhyas L, McKay A, MajeedA.Prevalence of Type 2 Diabetes in the States of the Co-Operation Council for the Arab States of the Gulf: A Systematic Review. Sesti G, ed. PLoS ONE. 2012;7:e40948.
Al-Quwaidhi AJ, Pearce MS, Sobngwi E, Critchley JA, O'Flaherty M. Comparison of type 2 diabetes prevalence estimates in Saudi Arabia from a validated Markov model against the International Diabetes Federation and other modelling studies. Diabetes Research and Clinical Practice. 2014;103:496-503. https://doi.org/10.1016/j.diabres.2013.12.036 PMid:24447810 PMCid:PMC4013554
NIH Consensus Development Panel on Osteoporosis Prevention. Diagnosis and Therapy, "Osteoporosis prevention, diagnosis and therapy," The Journal of the American Medical Association. 2001;285:785â€“795. https://doi.org/10.1001/jama.285.6.785 PMid:11176917
Zhang X, Lin J, Yang X, Wang B, Yang Y, Li J et al.[Investigation of osteoporosis prevalence and osteoporosis-related clinical risk factors among healthy elderly male]. Zhonghua Yi Xue Za Zhi. 2015;95:3366-9. PMid:26812978
Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Science & Medicine. 2016;3:e000098. https://doi.org/10.1136/lupus-2015-000098 PMid:26848397 PMCid:PMC4731833
Sarkis KS, Salvador MB, Pinheiro MM, Silva RG, Zerbini CA, Martini LA. Association between osteoporosis and rheumatoid arthritis in women: a cross-sectional study. Sao Paulo Med J. 2009;127:216-22. https://doi.org/10.1590/S1516-31802009000400007 PMid:20011927
Alwahhabi BK. Osteoporosis in Saudi Arabia: Are we doing enough? Saudi Medical Journal. 2015;36:1149-1150. https://doi.org/10.15537/smj.2015.10.11939 PMid:26446322 PMCid:PMC4621717
Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes. Int J Endocrinol. 2014:820615. https://doi.org/10.1155/2014/820615
Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166:495-505. https://doi.org/10.1093/aje/kwm106 PMid:17575306
Mastrandrea LD, Wactawski-Wende J, Donahue RP, Hovey KM, Clark A, Quattrin T. Young women with type 1 diabetes have lower bone mineral density that persists over time. Diabetes Care. 2008;31:1729-35. https://doi.org/10.2337/dc07-2426 PMid:18591404 PMCid:PMC2518333
Saito M, Marumo K. Bone Quality in Diabetes. Frontiers in Endocrinology. 2013;4:72. https://doi.org/10.3389/fendo.2013.00072 PMid:23785354 PMCid:PMC3682213
deLiefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int. 2005;16 : 1713-1720. https://doi.org/10.1007/s00198-005-1909-1 PMid:15940395
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19: 385-397. https://doi.org/10.1007/s00198-007-0543-5 PMid:18292978 PMCid:PMC2267485
Mathen PG, Thabah MM, Zachariah B, Das AK. Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes. JCDR. 2015; 9:OC08-OC12. https://doi.org/10.7860/jcdr/2015/14390.6450
American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33:S62-S69. https://doi.org/10.2337/dc10-S062 PMid:20042775 PMCid:PMC2797383
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359: 1929-1936. https://doi.org/10.1016/S0140-6736(02)08761-5
Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes--a meta-analysis. Osteoporos Int. 2007;18:427-44. https://doi.org/10.1007/s00198-006-0253-4 PMid:17068657
Lo SS. Bone health status of postmenopausal Chinese women. Hong Kong Med J. 2015;21:536-41. PMid:26492837
Lin LP, Hsu SW, Yao CH, et al.Risk for osteopenia and osteoporosis in institution-dwelling individuals with intellectual and/or developmental disabilities. Res Dev Disabil. 2014;36C:108-113. PMid:25462471
Betancourt Ortiz SL. [Bone mineral density, dietary calcium and risk factor for presumptive osteoporosis in Ecuadorian aged women]. Nutr Hosp. 2014;30:372-84. PMid:25208793
Billington EO, Grey A, Bolland MJ. The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and meta-analysis. Diabetologia. 2015; 58:2238-46. https://doi.org/10.1007/s00125-015-3660-2 PMid:26109213
Monami M, Cresci B, Colombini A, et al. Bone fractures and hypoglycemic treatment in type 2 diabetic patients. Diabetes Care. 2008; 31 : 199â€“203. https://doi.org/10.2337/dc07-1736 PMid:18024851
Kumar BS, Ravisankar A, Mohan A, Kumar DP, Katyarmal DT, Sachan A, et al. Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus & occurrence of osteoporosis. Indian J Med Res. 2015;141:431-7. https://doi.org/10.4103/0971-5916.159287 PMid:26112844 PMCid:PMC4510723
Chen H, Deng L, Li J. Prevalence of Osteoporosis and Its Associated Factors among Older Men with Type 2 Diabetes. International Journal of Endocrinology. 2013:285729. https://doi.org/10.1155/2013/285729
Heaney RP, Barger-Lux MJ, Davies KM, Ryan RA, Johnson ML, Gong G. Bone dimensional change with age: interactions of genetic, hormonal, and body size variables. Osteoporos Int. 1999;7:426â€“31. https://doi.org/10.1007/PL00004150
Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Therapeutics and Clinical Risk Management. 2008; 4:827-836. https://doi.org/10.2147/TCRM.S3552 PMid:19209265 PMCid:PMC2621390
Kota S, Jammula S, Kota S, Meher L, Modi K. Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density. Indian Journal of Orthopaedics. 2013;47:402-407. https://doi.org/10.4103/0019-5413.114932 PMid:23960286 PMCid:PMC3745696
How to Cite
All rights reserved.