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Holloway-Kew KL, Betson A, Rufus-Membere PG, Gaston J, Diez-Perez A, Kotowicz MA, Pasco JA. Impact microindentation in men with impaired fasting glucose and type 2 diabetes. Bone 2021; 142:115685. [PMID: 33049369 DOI: 10.1016/j.bone.2020.115685] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Individuals with type 2 diabetes (T2DM) are at increased fracture risk, with bone mineral density (BMD) measurements underestimating risk. Impact microindentation (IMI), a technique that measures bone microindentation distances, expressed as bone material strength index (BMSi), may improve fracture risk estimation in individuals with T2DM. This study describes the relationship between BMSi and glycaemia status in men and makes a comparison with bone measures from dual energy X-ray absorptiometry (DXA). MATERIAL AND METHODS Participants were 340 men aged 33-96 yr from the Geelong Osteoporosis Study. Impaired fasting glucose (IFG) was defined using fasting plasma glucose (FPG) between 5.5 and 6.9 mmol/L. Diabetes was defined as FPG ≥ 7.0 mmol/L, use of antihyperglycemic medication and/or self-report. Two participants with type 1 diabetes were excluded. BMSi was measured using an OsteoProbe. Femoral neck (FNBMD) and lumbar spine (LSBMD) were measured using DXA (Lunar Prodigy) and trabecular bone score (TBS) was calculated (TBS iNsight Version 2.2). Using linear regression techniques, the relationship between glycaemia status and BMSi was evaluated, adjusting for other potential confounders (including lifestyle factors, clinical measurements and FNBMD). Glycaemia status was also considered as a binary variable (T2DM vs normoglycaemia and IFG). RESULTS There were 234 (68.8%) men with normoglycaemia, 59 (17.4%) with IFG and 47 (13.8%) with diabetes. When considering glycaemia status as a binary variable, men with T2DM had lower mean BMSi compared to those without T2DM (normoglycaemia and IFG combined) (79.8; 95%CI 77.0-82.6 vs 83.0; 82.2-83.8 p = 0.043) and this difference in BMSi was independent of FNBMD. No differences were observed for either FNBMD or LSBMD; however, TBS was lower (1.177; 1.121-1.233 vs 1.256; 1.240-1.272, p = 0.015, independent of FNBMD). For glycaemia status considered in three groups, there were no differences in mean BMSi values between men with normoglycaemia, IFG and T2DM (82.9 (95%CI 82.0-83.8), 83.5 (81.8-85.2) and 79.8 (77.0-82.6), respectively; ANCOVA, p = 0.104). CONCLUSIONS Measures reflecting bone material properties and microarchitecture (BMSi and TBS) might be better than measures of bone mass (BMD) in identifying individuals with T2DM at risk of fracture.
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Affiliation(s)
| | | | | | | | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Spain
| | - Mark A Kotowicz
- Deakin University, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Barwon Health, Geelong, Australia
| | - Julie A Pasco
- Deakin University, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Barwon Health, Geelong, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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Holloway-Kew KL, Marijanovic N, De Abreu LLF, Sajjad MA, Pasco JA, Kotowicz MA. Bone mineral density in diabetes and impaired fasting glucose. Osteoporos Int 2019; 30:1799-1806. [PMID: 31367948 DOI: 10.1007/s00198-019-05108-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/23/2019] [Indexed: 02/06/2023]
Abstract
UNLABELLED We report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher lumbar spine bone mineral density (LSBMD). Femoral neck bone mineral density (FNBMD) was higher in obese post-menopausal women with diabetes. Only non-obese post-menopausal women with impaired fasting glucose (IFG) had a higher LSBMD than normoglycaemia. No other associations with IFG were observed. INTRODUCTION Individuals with diabetes have a higher or normal bone mineral density (BMD) compared with those without diabetes. However, paradoxically, they also have a higher fracture risk. It is not clear whether those with IFG also have altered BMD. This study aimed to determine whether individuals with IFG have elevated or normal BMD. METHODS Women (n = 858) and men (n = 970) (aged 20-80 years) from the Geelong Osteoporosis Study were included. IFG was defined as fasting plasma glucose (FPG) 5.5-6.9 mmol/L and diabetes as FPG ≥ 7.0 mmol/L, use of antihyperglycaemic medication and/or self-report. Using multivariable linear regression, the relationships between glycaemia and BMD at the femoral neck and lumbar spine were examined, and adjusted for age, body mass index (BMI), and other variables. In women, two interaction terms were identified: menopause × glycaemia and BMI × glycaemia, and thus, the analyses were stratified by menopause and obesity status (BMI cut point ≥ 30 kg/m2). RESULTS There were no associations between glycaemic status and BMD for pre-menopausal women. For non-obese post-menopausal women, there was no association between FNBMD and glycaemic status, but women with IFG or diabetes had higher LSBMD than those with normoglycaemia (7.1% and 9.7%, respectively, both p < 0.01). Obese post-menopausal women with diabetes had a higher FNBMD (8.8%, p = 0.008) and LSBMD (12.2%, p < 0.001), but those with IFG were not different from the normoglycaemia group. There were no associations detected between glycaemic status and BMD in men. CONCLUSIONS In this study, we report that compared with normoglycaemia, post-menopausal women (non-obese and obese) with diabetes had higher LSBMD. FNBMD was higher in obese post-menopausal women with diabetes. Only non-obese post-menopausal women with IFG had a higher LSBMD than normoglycaemia. No other associations with IFG were observed.
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Affiliation(s)
- K L Holloway-Kew
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, Level 3, PO Box 281, Geelong, VIC, 3220, Australia.
| | - N Marijanovic
- Barwon Health, University Hospital Geelong, Geelong, Australia
| | - L L F De Abreu
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, Level 3, PO Box 281, Geelong, VIC, 3220, Australia
| | - M A Sajjad
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, Level 3, PO Box 281, Geelong, VIC, 3220, Australia
| | - J A Pasco
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, Level 3, PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, University Hospital Geelong, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M A Kotowicz
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, Level 3, PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, University Hospital Geelong, Geelong, Australia
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Davidson MA, Mattison DR, Azoulay L, Krewski D. Thiazolidinedione drugs in the treatment of type 2 diabetes mellitus: past, present and future. Crit Rev Toxicol 2017; 48:52-108. [PMID: 28816105 DOI: 10.1080/10408444.2017.1351420] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thiazolidinedione (TZD) drugs used in the treatment of type 2 diabetes mellitus (T2DM) have proven effective in improving insulin sensitivity, hyperglycemia, and lipid metabolism. Though well tolerated by some patients, their mechanism of action as ligands of peroxisome proliferator-activated receptors (PPARs) results in the activation of several pathways in addition to those responsible for glycemic control and lipid homeostasis. These pathways, which include those related to inflammation, bone formation, and cell proliferation, may lead to adverse health outcomes. As treatment with TZDs has been associated with adverse hepatic, cardiovascular, osteological, and carcinogenic events in some studies, the role of TZDs in the treatment of T2DM continues to be debated. At the same time, new therapeutic roles for TZDs are being investigated, with new forms and isoforms currently in the pre-clinical phase for use in the prevention and treatment of some cancers, inflammatory diseases, and other conditions. The aims of this review are to provide an overview of the mechanism(s) of action of TZDs, a review of their safety for use in the treatment of T2DM, and a perspective on their current and future therapeutic roles.
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Affiliation(s)
- Melissa A Davidson
- a Faculty of Health Sciences , University of Ottawa , Ottawa , Canada.,b McLaughlin Centre for Population Health Risk Assessment , Ottawa , Canada
| | - Donald R Mattison
- b McLaughlin Centre for Population Health Risk Assessment , Ottawa , Canada.,c Risk Sciences International , Ottawa , Canada
| | - Laurent Azoulay
- d Center for Clinical Epidemiology , Lady Davis Research Institute, Jewish General Hospital , Montreal , Canada.,e Department of Oncology , McGill University , Montreal , Canada
| | - Daniel Krewski
- a Faculty of Health Sciences , University of Ottawa , Ottawa , Canada.,b McLaughlin Centre for Population Health Risk Assessment , Ottawa , Canada.,c Risk Sciences International , Ottawa , Canada.,f Faculty of Medicine , University of Ottawa , Ottawa , Canada
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Xia JW, Tan SJ, Zhang XL, Jun T, Sun XK, Ling W. Correlation of serum testosterone with insulin resistance in elderly male type 2 diabetes mellitus patients with osteoporosis. J Diabetes Investig 2015; 6:548-52. [PMID: 26417412 PMCID: PMC4578494 DOI: 10.1111/jdi.12291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 08/18/2014] [Accepted: 09/18/2014] [Indexed: 12/26/2022] Open
Abstract
AIMS/INTRODUCTION The present study was designed to investigate the correlations between the serum testosterone level and insulin sensitivity in elderly male type 2 diabetes patients with osteoporosis. MATERIALS AND METHODS A total of 35 elderly male patients with type 2 diabetes (type 2 diabetes group), 30 elderly male type 2 diabetes patients combined with osteoporosis (DO group) and 30 healthy elderly men (normal control group) participated in the present study. The fasting plasma glucose, fasting insulin, testosterone (T) and estradiol (E2) were measured. The insulin sensitivity index (ISI), homeostasis model assessment of insulin resistance (HOMA-IR) and E2/T were calculated. Then, the correlations of serum testosterone level with ISI and HOMA-IR were analyzed by statistical methods. RESULTS The HOMA-IR, E2 and E2/T of the type 2 diabetes group and DO group were significantly increased, whereas the bone mineral density, ISI, T and sex hormone binding globulin were decreased compared with those of the normal control group. Serum testosterone levels of the type 2 diabetes group and DO group were negatively correlated to the HOMA-IR (r = -0.496, -0.506; P < 0.05), whereas they were positively correlated to the fasting insulin (r = 0.281, 0.292; P < 0.05) and ISI (r = 0.364, 0.403; P < 0.05). CONCLUSIONS The reduced level of serum testosterone in elderly male type 2 diabetes patients with osteoporosis might promote insulin resistance.
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Affiliation(s)
- Jin-Wei Xia
- Department of Geriatrics, the First Affiliated Hospital of Suzhou University Suzhou, China
| | - Shi-Jin Tan
- Department of Geriatrics, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai, China
| | - Xing-Liang Zhang
- Department of Geriatrics, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai, China
| | - Tao Jun
- Department of Geriatrics, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai, China
| | - Xiao-Kang Sun
- Department of Geriatrics, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai, China
| | - Wang Ling
- Department of Geriatrics, the First Affiliated Hospital of Suzhou University Suzhou, China
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Boonchaya-anant P, Hardy E, Borg BB, Burshell AL. Bone mineral density in patients with nonalcoholic steatohepatitis among end-stage liver disease patients awaiting liver transplantation. Endocr Pract 2014; 19:414-9. [PMID: 23337159 DOI: 10.4158/ep12319.or] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Several studies have shown that patients with end-stage liver disease (ESLD) have lower bone mineral density (BMD) and a higher prevalence of osteoporosis compared to an age-matched population. Hyperinsulinemia and insulin resistance are typically associated with increased BMD. We hypothesized that patients with nonalcoholic steatohepatitis (NASH) and underlying insulin resistance may have higher BMD than patients with cirrhosis from other causes. METHODS We performed a retrospective chart review of patients with ESLD who underwent liver transplant evaluation at Ochsner Clinic Foundation and had a BMD study as part of initial work up and compared BMD values of patients diagnosed with NASH to patients with cirrhosis due to other causes. Patients were categorized into 3 groups based on the etiology of their liver disease as NASH, alcoholic cirrhosis, or viral hepatitis C or B (HCV/HBV). RESULTS A total of 63 patients met the study inclusion criteria, including 15 with NASH, 17 with alcoholic cirrhosis, and 31 with HCV/HBV. The overall prevalence rates of osteopenia and osteoporosis were 44% and 12%, respectively. BMD values were higher in the NASH group than the HCV/HBV group at lumbar spine, total hip, and femoral neck (P = .01, .03, and .02, respectively). There were no statistical differences in BMD values between NASH and alcoholic cirrhosis groups at any site. CONCLUSIONS We found a high prevalence of low BMD among patients with ESLD awaiting liver transplantation. NASH patients had higher BMDs than HCV/HBV patients. The effects of NASH and insulin resistance on bone are complex and should be examined further.
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Arikan S, Tuzcu A, Bahceci M, Ozmen S, Gokalp D. Insulin resistance in type 2 diabetes mellitus may be related to bone mineral density. J Clin Densitom 2012; 15:186-90. [PMID: 22321655 DOI: 10.1016/j.jocd.2011.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 11/19/2011] [Accepted: 11/20/2011] [Indexed: 11/17/2022]
Abstract
The mechanism of bone mineral density (BMD) changes in type 2 diabetes mellitus is not clear. We aimed to investigate the effect of insulin resistance in type 2 diabetics on BMD. Insulin resistance was determined using the homeostasis model assessment index (HOMA-IR). Nineteen type 2 diabetic patients with a HOMA-IR <2.7 (mean age, 51.5±9.6yr; body mass index [BMI], 27.3±5.1kg/m(2); duration of diabetes, 10.5±7.3yr) were included in Group A, and 30 BMI- and age-matched type 2 diabetic patients with a HOMA-IR ≥2.7 were included in Group B. The BMD was measured with dual-energy X-ray absorptiometry. Independent t-test was used for statistical analysis. The Group A values for mean fasting glucose and insulin levels were 160.1±77.0mg/dL and 4.79±2.89μU/L, respectively, whereas the Group B values were 195.1±58.9mg/dL (p>0.05) and 19.30±16.89μU/L (p=0.0001). Significantly higher total lumbar vertebra T-score (p=0.02) and total lumbar vertebra BMD in Group A were determined than Group B (p=0.033). The lumbar vertebra total Z-score was significantly lower in Group B (p=0.042). Marked insulin resistance may have a negative effect on BMD in type 2 diabetics, while the presence of hyperinsulinemia may be associated with the low BMD.
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Affiliation(s)
- Senay Arikan
- Department of Endocrinology, Dicle University Medical Faculty, Diyarbakır, Turkey.
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Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez JM, Luque Fernández I, Varsavsky M, Guadalix Iglesias S, Cano Rodriguez I, Ballesteros Pomar MD, Vidal Casariego A, Rozas Moreno P, Cortés Berdonces M, Fernández García D, Calleja Canelas A, Palma Moya M, Martínez Díaz-Guerra G, Jimenez Moleón JJ, Muñoz Torres M. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. ACTA ACUST UNITED AC 2012; 59:174-96. [PMID: 22321561 DOI: 10.1016/j.endonu.2012.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.
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Abdulameer SA, Sulaiman SAS, Hassali MAA, Subramaniam K, Sahib MN. Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do? Patient Prefer Adherence 2012; 6:435-48. [PMID: 22791981 PMCID: PMC3393120 DOI: 10.2147/ppa.s32745] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus (DM) is a pandemic and chronic metabolic disorder with substantial morbidity and mortality. In addition, osteoporosis (OP) is a silent disease with a harmful impact on morbidity and mortality. Therefore, this systematic review focuses on the relationship between OP and type 2 diabetes mellitus (T2DM). Systematic reviews of full-length articles published in English from January 1950 to October 2010 were identified in PubMed and other available electronic databases on the Universiti Sains Malaysia Library Database. The following keywords were used for the search: T2DM, OP, bone mass, skeletal. Studies of more than 50 patients with T2DM were included. Forty-seven studies were identified. The majority of articles (26) showed increased bone mineral density (BMD), while 13 articles revealed decreased BMD; moreover, eight articles revealed normal or no difference in bone mass. There were conflicting results concerning the influence of T2DM on BMD in association with gender, glycemic control, and body mass index. However, patients with T2DM display an increased fracture risk despite a higher BMD, which is mainly attributable to the increased risk of falling. As a conclusion, screening, identification, and prevention of potential risk factors for OP in T2DM patients are crucial and important in terms of preserving a good quality of life in diabetic patients and decreasing the risk of fracture. Patients with T2DM may additionally benefit from early visual assessment, regular exercise to improve muscle strength and balance, and specific measures for preventing falls. Patient education about an adequate calcium and vitamin D intake and regular exercise is important for improving muscle strength and balance. Furthermore, adequate glycemic control and the prevention of diabetic complications are the starting point of therapy in diabetic patients.
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Affiliation(s)
- Shaymaa Abdalwahed Abdulameer
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Correspondence: Shaymaa Abdalwahed Abdulameer, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia, Tel +60 4 603 5422, Fax +60 4 657 0017, Email
| | | | | | | | - Mohanad Naji Sahib
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Cvijetic S, Pavlovic M, Pasalic D, Dodig S. Ultrasound bone measurement in an older population with metabolic syndrome. Aging Clin Exp Res 2011; 23:29-34. [PMID: 21499017 DOI: 10.1007/bf03324950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome and osteoporosis are recognized as major public health problems in many countries. This study investigated the association between bone quality and components of metabolic syndrome in an elderly population. METHODS The study included a population sample of 211 men and women, of mean age 77.9 ± 4.5 years. Anthropometry, blood pressure, serum levels of lipoproteins (HDL and LDL), triglycerides and glucose were measured, and ultrasound bone densitometry was performed in all subjects. Information on lifestyle habits, including physical activity, smoking and alcohol consumption, were obtained by a questionnaire. RESULTS Metabolic syndrome, defined by the criteria of the International Diabetes Federation, was determined in 59% of men and 65% of women. The quantitative ultrasound index (QUI) was significantly correlated with serum glucose in men (r=-0.31; p=0.005) and with body mass index (BMI) in women (r=0.39; p<0.0001). QUI was significantly lower in men with metabolic syndrome (F=7.57; p<0.007) and significantly higher in women with it (F=6.47; p=0.012) compared with controls. When QUI was adjusted for body mass index in women and for serum glucose in men, it was no longer significantly different from values for controls. Other covariates such as cholesterol, blood pressure, smoking, alcohol, and physical activity did not change the difference in QUI between patients with metabolic syndrome and controls. Diabetes in men (p=0.005) and obesity and waist circumference in women (p<0.05) were also significant predictors of QUI in regression analysis. CONCLUSIONS The association between metabolic syndrome and bone stiffness in elderly people may be explained by increased BMI in women and high serum glucose in men.
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