Hormonal alterations in experimental diabetes: role of a primary disturbance in calcium homeostasis

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

Subjects with type 1 diabetes mellitus (T1DM) have decreased bone mineral density and an up to sixfold increase in fracture risk. Yet bone fragility is not commonly regarded as another unique complication of diabetes. Both animals with experimentally induced insulin deficiency syndromes and patients with T1DM have impaired osteoblastic bone formation, with or without increased bone resorption. Insulin/IGF1 deficiency appears to be a major pathogenetic mechanism involved, along with glucose toxicity, marrow adiposity, inflammation, adipokine and other metabolic alterations that may all play a role on altering bone turnover. In turn, increasing physical activity in children with diabetes as well as good glycaemic control appears to provide some improvement of bone parameters, although robust clinical studies are still lacking. In this context, the role of osteoporosis drugs remains unknown.

Changes in the concentration of microelements in the teeth of rats in the final stage of type 1 diabetes, with an absolute lack of insulin

The mineral content of tooth hard tissue may influence the rate of decay change. Considering this fact, we aimed at examining if type 1 diabetes might be a contributing factor to the appearance of tooth decay. The experiment was conducted on female Wistar rats. To induce diabetes, rats were intravenously injected with 1 mL streptozocine 0.01 M citrate buffer. The control group of rats was injected with 1 mL 0.01 M citrate buffer only. After 10 days, teeth and blood serum samples were obtained. Fluoride concentration was determined by potentiometer method, and calcium and magnesium, by AAS. Serum concentrations of glucose and estradiol in the diabetic rats were significantly higher compared to the control group. In the experimental group, a statistically significant decrease of fluorine concentration in both teeth and serum were observed. Calcium and magnesium concentrations in blood serum and dental magnesium concentration were significantly higher in rats with type 1 diabetes compared with the control. A downward trend in the content of dental calcium in streptozotocin-induced diabetic rats was observed. The results obtained indicate that caries initiation and progression could be promoted by metabolic changes associated with diabetes affecting the mineral composition of tooth hard tissue.

Tetracycline prevents cancellous bone loss and maintains near-normal rates of bone formation in streptozotocin diabetic rats

The skeletal consequences of streptozotocin-induced (STZ) diabetes in the rat are characterized by decreased bone formation and, consequently, reductions in bone mass. Given the ability of tetracyclines to inhibit the breakdown of connective tissue collagen in experimental diabetes (and in other diseases), we examined the potential of this drug to prevent the osteopenia associated with STZ diabetes. To evaluate drug efficacy, the cortical and trabecular bone histomorphometry were analyzed and compared between vehicle-treated control and diabetic rats and control and diabetic rats treated orally with 20 mg/day of minocycline, a semisynthetic tetracycline. In addition, blood and urine glucose, body weight change, tibia lengths, cortical bone densities, and bone ash content were compared. At the end of the 26 day experimental period, diabetic (D) and minocycline-treated diabetic (MTD) rats were polyuric with reduced body weights and significantly elevated blood and urinary glucose levels (p < 0.01). Compared to control (C) and minocycline-treated control (MTC) animals, the periosteal and cancellous bone formation in the D rats had virtually ceased (p < 0.001), and the cancellous bone mass in the tibial metaphysis was reduced 47% (p < 0.01). In contrast, bone formation rates in the MTD animals were increased compared to the D rats (p < 0.001), while cancellous bone areas in the MTD animals were essentially equivalent to those observed in the C and MTC groups. Moreover, growth plate thickness, reduced 43% in the D rats, was preserved in the diabetic animals treated with minocycline. These results demonstrate that minocycline treatment of the streptozotocin diabetic rat maintains normal bone formation, normalizes growth plate thickness, and prevents cancellous bone loss.

Growth and development of bone mass in untreated alloxan diabetic rats. Effects of collagen glycosylation and parathyroid activity on bone turnover

Body and skeletal growth and development were studied in alloxan-treated and age-matched control rats, between 3 and 23 weeks of age. For both groups the growth of the skeletal and body weights were in phase, with a maximum at 7 weeks of age. The growth data was assessed according to Parks' theory of feeding and growth. Alloxan-treated rats showed an important reduction in body and bone mass, with a greater impact on soft tissues. As expected, the asymptotic body and skeletal weights were reduced respect to controls. The time needed to attain 63% of mature food intake (Brody's 'time constant') was also reduced, indicating that maturation occurred at an earlier age than controls. The diabetic state is characterized by a reduced food conversion efficiency. Despite hyperfagia, alloxan-treated rats showed circa one-half the body and skeletal weights of age-matched controls. The following adverse effects of alloxan diabetes on bone tissue were observed: (a) a decrease in trabecular bone volume (femoral metaphyses) and cortical width (femoral diaphyses), (b) increased bone collagen glycosylation as a function of extracellular glucose concentration, (c) increased resistance of bone collagen to collagenase hydrolysis, (d) decreased rate of bone resorption except under strongly stimulated parathyroid function, (d) significantly lower ashes/bone matrix ratio in diabetic rats with more than 10 weeks of diabetes, and (e) no histological evidence of osteomalacia.

Increased clearance of 1,25(OH)2D3 and tissue-specific responsiveness to 1,25(OH)2D3 in diabetic rats

The kinetics of 1,25-dihydroxyvitamin D3 [1,25(OH)2-D3] and the in vivo response to 1,25(OH)2D3 (7.5, 15, and 30 ng/100 g body wt), infused or injected subcutaneously for 12-14 days, were studied in male spontaneously diabetic and control BB rats. In control rats, increasing doses of 1,25(OH)2D3 produced parallel increases in plasma 1,25(OH)2D3 and calcium, urinary calcium, duodenal CaBP9K, and renal CaBP28K. 1,25-(OH)2D3 at 30 ng/100 g markedly raised plasma osteocalcin and osteoblast/osteoid surfaces in the tibial metaphysis, but inhibited bone mineralization rate. In diabetic rats, plasma 1,25-(OH)2D3 concentrations were decreased, and the rise of plasma 1,25(OH)2D3 during 1,25(OH)2D3 infusion was blunted, but the free 1,25(OH)2D3 index remained normal or above normal. Diabetic rats had an increased metabolic clearance rate of 1,25-(OH)2D3 (0.38 +/- 0.015 vs. 0.24 +/- 0.007 ml.min-1.kg-1), with no further increase in 1,25(OH)2D3-infused diabetic rats; their relative production rate of 1,25(OH)2D3 was unchanged. The responses of plasma and urinary calcium, duodenal CaBP9K, and renal CaBP28K to infused 1,25(OH)2D3 were normal, as was duodenal calcium absorption in 1,25(OH)2D3-injected diabetic rats. However, the virtual absence of osteoblasts/osteoid in trabecular bone was unaltered in diabetic rats infused with 30 ng/100 g 1,25(OH)2D3, with only minimal increase of their low plasma osteocalcin levels. 1,25(OH)2D3 treatment therefore cannot be expected to reverse diabetic osteopenia.

Morphological characteristics of the depository surface of alveolar bone of diabetic mice

Sharpey's fibers support teeth by attachment of periodontal ligament fibers to alveolar bone. The effects of diabetes mellitus on this support mechanism have not been described and were the subject of this study. Male Swiss mice were rendered diabetic by streptozotocin. Mandibles were removed 9 weeks after injections, the mineralizing front of the depository surface of the interdental septum was exposed by fracture through the periodontal ligament, rendered anorganic, and examined by scanning electron microscopy. No significant reduction in alveolar crest height was evident in diabetic as compared to control animals; however, significant changes in the a) mineralization patterns of bone depository surfaces and Sharpey's fibers, and b) number of Sharpey's fibers inserting into alveolar bone were evident in diabetics. Unmineralized fissures, characteristic of Sharpey's fibers of control, were nearly obliterated by mineralized tissue in diabetic animals. The mineralizing front of the middle and apical thirds of the diabetic alveolar wall was covered by numerous large calcified globules resembling enlarged calcospherites, which were not evident over the cervical third or control tissues. The mean Sharpey fiber density was greater in controls than in diabetics (p less than 0.001); however, there was no significant difference between their mean diameters. These observations suggest that, in early diabetes, Sharpey's fibers and depository surfaces of the middle and apical thirds of the interdental septum have morphologic evidence of aging, which precedes significant reduction in alveolar crest height. These changes may weaken the attachment of periodontal ligament fibers to bone and reduce resistance of the periodontium to intrusive forces.

Calcium metabolism of rats with varying degrees of insulinopenia

This paper reports an investigation designed to determine the influence of varying degrees of insulinopenia upon the calcium metabolism of actively growing, alloxan-treated rats fed diets with three levels of calcium. A significant reduction in the skeletal mass (in absolute terms) was observed one month after alloxan administration in rats fed diets with normal or high calcium contents. The impact of insulin deficiency was greater on bone collagen than on the mineral mass, as shown by the increased calcium/hydroxyproline ratio. Alloxan-treated rats showed rather increased levels of PTH which was at variance with respect to control animals and unrelated to the calcium content of the diet. In spite of the high PTH levels, diabetic rats showed significantly diminished rates of bone Ca accretion and resorption. In addition, the animals fed the diet with the normal Ca content, showed significantly reduced areas of osteocytes lacunae and hypocalcemia after 24 h of fasting. The overall information obtained indicates that, in the rat, insulin deficiency more pronouncedly affects organic matrix than mineral turnover. The diabetic state is characterized by an impaired response of bone tissue to physiological stimuli, which is attributed to defective cellular activity caused by insulin deficit. Diminished bone resorption is considered to be an adaptative response to preserve bone mass.

Osteocalcin levels in diabetic subjects

Because a series of reports suggests the existence of altered bone and mineral metabolism in diabetes mellitus, we studied 106 diabetic subjects (42 insulin-dependent (IDD) and 64 noninsulin dependent (NIDD] to determine whether a difference in bone turnover (evaluated by serum osteocalcin (OC] could be found in comparison with normal controls. OC levels in diabetic subjects were lower than the age- and sex-specific predicted values. The reduction was especially evident in male and female NIDD (Z-score: - 1.12 +/- 0.92, t = 8.4, P less than 0.001 and -0.84 +/- 0.86, t = 4.0, P less than 0.01, respectively) and male IDD (Z-score: - 0.90 +/- 0.86, t = 4.5, P less than 0.01). The mean Z-score for female IDD, albeit negative (-0.31 +/- 0.79; t = 1.6; 0.2 greater than P greater than 0.1), was not significantly different from normal. Total serum calcium (Ca) and calcitonin (CT) showed an opposite pattern, being higher in all the diabetic subgroups (with the exception of Ca in female IDD), whereas parathyroid hormone (PTH) was lower than expected in each diabetic subset. By multiple regression analysis, the reduction of OC was related to PTH and CT levels and to the type of treatment. Subjects controlled with diet showed differences of greater magnitude from the expected normal values than those treated with oral hypoglycemic agents or insulin (Z-score: -1.28 +/- 1.05 vs. -0.85 +/- 0.90 and -0.63 +/- 0.97, respectively; P = 0.05). However, the variance explained by these three factors was small, suggesting that other variables (possibly 1 alpha,25(OH)2D) exerted important influences on OC levels.