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Effects of obesity and diabetes on rate of bone density loss

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Abstract

Summary

In this large registry-based study, women with diabetes had marginally greater bone mineral density (BMD) loss at the femoral neck but not at other measurement sites, whereas obesity was not associated with greater BMD loss. Our data do not support the hypothesis that rapid BMD loss explains the increased fracture risk associated with type 2 diabetes and obesity observed in prior studies.

Introduction

Type 2 diabetes and obesity are associated with higher bone mineral density (BMD) which may be less protective against fracture than previously assumed. Inconsistent data suggest that rapid BMD loss may be a contributing factor.

Methods

We examined the rate of BMD loss in women with diabetes and/or obesity in a population-based BMD registry for Manitoba, Canada. We identified 4960 women aged ≥ 40 years undergoing baseline and follow-up BMD assessments (mean interval 4.3 years) without confounding medication use or large weight fluctuation. We calculated annualized rate of BMD change for the lumbar spine, total hip, and femoral neck in relation to diagnosed diabetes and body mass index (BMI) category.

Results

Baseline age-adjusted BMD was greater in women with diabetes and for increasing BMI category (all P < 0.001). In women with diabetes, unadjusted BMD loss was less at the lumbar spine (P = 0.017), non-significantly greater at the femoral neck (P = 0.085), and similar at the total hip (P = 0.488). When adjusted for age and BMI, diabetes was associated with slightly greater femoral neck BMD loss (− 0.0018 g/cm2/year, P = 0.012) but not at the lumbar spine or total hip. There was a strong linear effect of increasing BMI on attenuated BMI loss at the lumbar spine with negligible effects on hip BMD.

Conclusions

Diabetes was associated with slightly greater BMD loss at the femoral neck but not at other measurement sites. BMD loss at the lumbar spine was reduced in overweight and obese women but BMI did not significantly affect hip BMD loss.

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Acknowledgements

This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. The authors acknowledge the Manitoba Centre for Health Policy for the use of data contained in the Manitoba Population Research Data Repository (HIPC File No. 2011/2012-31). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. The data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health.

Funding

No funding support was received for this research project. SNM is chercheur-clinicienne boursier des Fonds de Recherche du Québec en Santé. LML is supported by Manitoba Health Research Chair. SRM holds the Endowed Chair in Patient Health Management supported by the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences at the University of Alberta.

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Authors and Affiliations

  1. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada

    W. D. Leslie & L. M. Lix

  2. St. Boniface Hospital, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada

    W. D. Leslie

  3. Department of Medicine, McGill University, Montreal, QC, Canada

    S. N. Morin

  4. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    S. R. Majumdar

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  1. W. D. Leslie
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  2. S. N. Morin
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  4. L. M. Lix
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Correspondence to W. D. Leslie.

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Conflicts of interest

Suzanne Morin: Consultant to: Amgen; Research Grants: Amgen, Merck.

William Leslie, Sumit Majumdar, Lisa Lix: None.

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Leslie, W.D., Morin, S.N., Majumdar, S.R. et al. Effects of obesity and diabetes on rate of bone density loss. Osteoporos Int 29, 61–67 (2018). https://doi.org/10.1007/s00198-017-4223-9

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  • DOI: https://doi.org/10.1007/s00198-017-4223-9

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