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Bone. 2017 Aug;101:156-161. doi: 10.1016/j.bone.2017.05.004. Epub 2017 May 6.

The association between insulin use and volumetric bone mineral density, bone micro-architecture and bone strength of the distal radius in patients with type 2 diabetes - The Maastricht study.

Author information

1
Maastricht University, Department of Internal Medicine, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. Electronic address: e.dewaard@maastrichtuniversity.nl.
2
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands. Electronic address: annemariek.driessen@mumc.nl.
3
Maastricht University, Department of Internal Medicine, Maastricht, The Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. Electronic address: joost.dejong@maastrichtuniversity.nl.
4
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University, Department of Family Medicine, Maastricht, The Netherlands. Electronic address: tineke.vangeel@maastrichtuniversity.nl.
5
Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Heart and Vascular Center, Maastricht, The Netherlands. Electronic address: rma.henry@mumc.nl.
6
Maastricht University Medical Center+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands; Radboud University Nijmegen Medical Center, Department of Pharmacy, Nijmegen, The Netherlands. Electronic address: Hein.vanOnzenoort@radboudumc.nl.
7
Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Heart and Vascular Center, Maastricht, The Netherlands. Electronic address: m.schram@mumc.nl.
8
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Maastricht University, Department of Epidemiology, Maastricht, The Netherlands. Electronic address: dagnelie@maastrichtuniversity.nl.
9
Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. Electronic address: c.vanderkallen@maastrichtuniversity.nl.
10
Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. Electronic address: s.sep@mumc.nl.
11
Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. Electronic address: cda.stehouwer@mumc.nl.
12
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands. Electronic address: n.schaper@mumc.nl.
13
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University, Department of Social Medicine, Maastricht, The Netherlands. Electronic address: a.koster@maastrichtuniversity.nl.
14
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Maastricht University, Department of Human Movement Science, Maastricht, The Netherlands. Electronic address: hans.savelberg@maastrichtuniversity.nl.
15
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands. Electronic address: c.neef@maastrichtuniversity.nl.
16
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; University of Hasselt, Biomedical Research Institute, Hasselt, Belgium. Electronic address: piet.geusens@scarlet.be.
17
Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Clinical Pharmacy and Toxicology, Maastricht, The Netherlands; MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton, United Kingdom. Electronic address: frank.de.vries@mumc.nl.
18
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Maastricht University Medical Center+, Department of Internal Medicine, Maastricht, The Netherlands; VieCuri Medical Center, Department of Internal Medicine, Subdivision of Endocrinology, Venlo, The Netherlands. Electronic address: jvdbergh@viecuri.nl.

Abstract

Type 2 diabetes mellitus (T2DM) has been associated with an increased risk of fractures, despite normal to increased bone mineral density (BMD). Insulin use is one of the factors linked to this increased fracture risk. However, direct negative effects of insulin on bone quality are not expected since insulin is thought to be anabolic to bone. In this cross-sectional study the association between insulin use and volumetric BMD (vBMD), bone micro-architecture and bone strength of the distal radius, as measured with HR-pQCT, was examined. Data from 50 participants with T2DM of The Maastricht Study (mean age 62±7.5years, 44% women) was used. Participants were classified as insulin user (n=13) or non-insulin user (n=37) based on prescription data. Linear regression analysis was used to estimate the association between current insulin use and HR-pQCT derived parameters. After adjustment for age, sex, body mass index, glycated hemoglobin A1c and T2DM duration, insulin use was associated with lower total vBMD (standardized beta (β):-0.56 (95% CI:-0.89 to -0.24)), trabecular vBMD (β:-0.58 (95% CI:-0.87 to -0.30)), trabecular thickness (β:-0.55 (95% CI:-0.87 to -0.23)), cortical thickness (β:-0.41 (95% CI:-0.74 to -0.08)), log cortical pore volume (β:-0.43 (95% CI:-0.73 to -0.13)), bone stiffness (β:-0.39 (95% CI:-0.62 to -0.17)) and failure load (β:-0.39 (95% CI:-0.60 to -0.17)) when compared to the non-insulin users. Insulin use was not associated with cortical vBMD, trabecular number, trabecular separation, cortical porosity and cortical pore diameter. This study indicates that insulin use is negatively associated with bone density, bone micro-architectural and bone strength parameters. These findings may partly explain the previously observed increased fracture risk in insulin users, although there may be residual confounding by other factors related to disease severity in insulin users.

KEYWORDS:

Bone micro-architecture; Bone strength; High-resolution peripheral quantitative computed tomography (HR-pQCT); Insulin use; Type 2 diabetes mellitus; Volumetric bone mineral density

PMID:
28487133
DOI:
10.1016/j.bone.2017.05.004
[Indexed for MEDLINE]

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