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Submitted on February 28, 2006
Accepted on May 18, 2006
Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Center for Medical Research, Medical University of Graz, Austria
* To whom correspondence should be addressed. E-mail: harald.dobnig{at}meduni-graz.at.
Context Fractures are a major health burden in elderly institutionalized persons. Type 2 diabetes mellitus (DM) has a high prevalence in nursing home patients and has been associated with positive effects on bone mass in younger, community dwelling elderly.
Objective To investigate whether type 2 DM affects bone mass, bone turnover or prospective fracture rates in frail, elderly women living in nursing homes.
Design, Setting, and Participants Prospective cohort study of 583 patients with type 2 DM and 1081 control individuals above 70 recruited from 95 nursing homes in Austria. Patients were enrolled and followed up by mobile study teams.
Main Outcome Measures We performed quantitative bone ultrasound measurements at the calcaneus, radius and proximal third phalanx, measurements of quadriceps strength and biochemical parameters of mineral metabolism and bone turnover. Patients were prospectively followed for hip and other non-vertebral fractures over two years.
Results Patients with type 2 DM had significantly higher age-, weight- and mobility score-adjusted calcaneal stiffness (P < 0.0001), radial SOS- (P < 0.005) and phalangeal SOS (P < 0.05) measurements when compared with controls. Mean serum parathyroid hormone (-20.7%) and osteocalcin levels (-22.3%) were significantly lower (both P < 0.0001) in patients with treated type 2 DM despite comparable low serum 25-hydroxyvitamin D levels and slightly higher adjusted total serum calcium levels compared with controls. Important independent determinants of bone turnover in both patient groups were parathyroid hormone, creatinine clearance, alanine aminotransferase as well as HbA1c levels, together accounting for 30 to 40% of its variance. A total of 110 hip fractures occurred during the observation period, corresponding to a hip fracture rate of 3.1% (in controls) and 3.4% (in type 2 DM) per 100 patient-years; this was not significantly different for controls and diabetics.
Conclusions Decreased parathyroid hormone levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover hip fracture risk is comparable to women without DM.
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