Evaluation of Bone Density Measurement in Type 2 Diabetic Postmenopausal Women with Hypertension and Hyperlipidemia

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1 pissn: , eissn: Jounal of Menopausal Medicine 2015;21:36-40 Oiginal Aticle Evaluation of Bone Density Measuement in Type 2 Diabetic ostmenopausal Women with Hypetension and Hypelipidemia Emel Kiyak Caglayan 1, Yapak Engin-Ustun 1, Nagihan Sai 1, Seyhan Kaacavus 2, Levent Seckin 1, Mustafa Kaa 1 1 Depatment of Obstetics and Gynecology, 2 Depatment of Nuclea Medicine, Bozok Univesity, Faculty of Medicine, Yozgat, Tukey Objectives: The aim of the study was to compae bone mineal density (BMD) in healthy postmenopausal women to BMD in type 2 diabetic hypetensive postmenopausal women with hypelipidemia. Methods: Fifty type 2 diabetic and hypetensive postmenopausal women with hypelipidemia and 51 age and body mass index (BMI) matched healthy postmenopausal women wee included. Lumba spine and femoal neck BMD wee noted in both goups. BMD was measued using dual enegy X-ay absoptiomety (DXA). Seum alkaline phosphatase (AL), calcium and phosphoous wee also measued. eason coelation coefficients wee used to establish the elationship between vaious clinical chaacteistics. Results: Thee wee no significant diffeences between two goups in espect to lumba and vetebal BMD values, age, BMI, gavidity, paity. Seum cholesteol and fasting glucose levels wee significantly diffeent between each goups ( = , = 0.002). Conclusion: We found that, accompanying chonic diseases such as diabetes, hypetension and hypelipidemia don t affect the BMD measuements at postmenopausal peiod. So these postmenopausal women don t have excess isk egading osteopoosis. (J Menopausal Med 2015;21:36-40) Key Wods: Bone density, Hypelipidemias, ostmenopause Intoduction Although it is geneally accepted that type 1 diabetes is associated with ten pecent less bone mineal density (BMD) value compaed with no diabetic adults, 1,2 thee is no consensus on osteopoosis isk in people with type 2 diabetes. Nicodemus and Folsom 3 found that women with type 2 diabetes had 1.70-fold highe isk of incident hip factue than women without diabetes. Two othe studies evealed no diffeence in bone density between type 2 diabetes patients and contol subjects. 4,5 Some have epoted highe bone mass in type 2 diabetic patients elative to no diabetic contol subjects. 6~8 The aim of this study to compae the BMD values of postmenopausal women with diabetic, hypetensive and hypelipidemic postmenopausal women Mateials and Methods The medical ecods and BMD measuements of 50 diabetic hypetensive postmenopausal women followed-up at ou institution fo 4 yeas wee evaluated etospectively. A cohot of women with known diabetes mellitus (DM) Received: Januay 27, 2015 Revised: Apil 3, 2015 Accepted: Apil 4, 2015 Addess fo Coespondence: Emel Kiyak Caglayan, Bozok Univesity Faculty of Medicine, Depatment of Obstetics and Gynecology, Adnan Mendees Bulvaı No:190 Yozgat, Tukey Tel: , Fax: , emelkiyak@hotmail.com Copyight 2015 by The Koean Society of Meno pause This is an Open Access aticle distibuted unde the tems of the Ceative Commons Attibution Non-Commecial License ( 36

2 Emel Kiyak Caglayan, et al. BMD in ostmenopausal Women with DM, HT was identified by etospectively eviewing ou patient database. Appoval (Date: , Numbe: 115) of the Bozok Univesity Medical School s local ethics committee has been obtained. aticipants wee natually postmenopausal women unde 70 yeas of age. Exclusion citeia included sugical menopause, smoking, chonic medical illness (Chonic Obstuctive Lung Disease). Essential hypetension and diabetes diagnosis was obtained fom hospital ecods. The diagnosis is made in ou hospital accoding to the Seventh Repot of the Joint National Committee on pevention, detection, evaluation, and teatment of high blood pessue and Wold Health Oganization (WHO) epot on the diagnosis and classification of DM. Women teated with diet o dugs o both; o eithe a fasting seum glucose value moe than 126 mg/dl descibe as known DM. atients who had essential hypetension peviously o patients whose blood pessue measuements had been moe than 140/90 wee included in the study. Those women with and hypetension who had undegone sceening BMD in ou institution wee identified; this goup of women compised ou study goup. Incease of tiglyceide (> 160 mg/dl) o cholesteol levels (> 200 mg/dl) ae descibed as hypelipidemia. Fifty-one healthy postmenopausal women wee also included in the study as the contol goup. Ou institution as a lage tetiay efeal cente, offes a compehensive menopause health pogam to ou patients with sceening BMD, mammogam and ap-test. Ou contol goup was selected fom these patients. Data included the age, gavidity, paity, body mass index (BMI), BMD measuements, seum alkaline phosphatase (AL), calcium and phosphoous levels wee collected. BMD was measued using dual enegy X-ay absoptiomety (DXA). BMD measuements of the hip (femoal neck) and lumba spine (L1-L4) wee pefomed in the anteio posteio (A) view fo the lumba spine DXA scanne (Hologic QDR 4500 Elite, Bedfod, MA, USA). The BMD value fo each egion was calculated as the atio of bone mineal content to the aea of the inteested egion (g/cm 2 ). Accoding to WHO Table 1. Demogaphic and clinical chaacteistics of the two goups atients (n = 50) Contol (n = 51) value BMI (kg/m 2 ) ± ± Age (yeas) ± ± 8.26 Gavidity 6.41 ± ± aity 4.49 ± ± TSKF ± ± 0.94 TSKV ± ± Total cholesteol (mg/dl) ± ± Fasting glucose (mmol/l)* 146 ( ) (82-96) Estadiol (pmol/l)* 10.4 (2-36) (3-30) 0.76 FSH (miu/ml) ± ± LH (miu/ml) ± ± Ca (mg/dl) 9.55 ± ± (mg/dl) 3.61 ± ± AL (IU/L)* (45-277) 97.4 (44-230) 0.21 Values ae expessed as mean ± standad deviation (SD) *Values ae median (minimum-maximum) AL: alkaline phosphatase, BMI: body mass index, Ca: calcium, FSH: follicle stimulating homone, HDL: high-density lipopotein, LDL: lowdensity lipopotein, LH: luteinizing homone, : phosphous, TG: tiglyceides, TSKF: T scoe femoal neck, TSKV: T scoe lumba veteba spine 37

3 Jounal of Menopausal Medicine 2015;21:36-40 citeia, a T-scoe of -1 denotes nomal bone, a T-scoe between -1 and -2.5 denotes osteopenia, and a T-scoe of -2.5 denotes osteopoosis. BMI wascalculatedbydividingthe weighttothesquae of height (kg/m 2 ). The statistical analyses wee pefomed using the SSS statistical package (SSS Inc., Chicago, IL, USA). The nomality of vaiables wee assessed using the Kolmogoov-Sminov test. The data wee epoted as mean ± standad deviation (fo nomally distibuted data) o as median and ange (fo non-nomally distibuted data). Fo data with nomal distibution, the Student t test was applied. Othewise, the Mann-Whitney U test was used as a nonpaametic test. Coelations between BMD and biochemical make levels wee made using eason s coelation coefficient and a patial coelation analysis afte adjustments fo age and menopausal time. A value of less than 0.05 was consideed significant. Results Thee wee no significant diffeences between two goups in espect to lumba and vetebal BMD values, age, BMI, gavidity, paity (Table 1). Seum cholesteol and fasting glucose levels wee significantly diffeent between each goups ( = , = 0.002). Thee wee no significant diffeences in seum AL, calcium and phosphoous levels between the diabetic patients and the contols. Thee was a negative coelation between lumba spine BMD and duation of menopause. But we didn t find a coelation between blood glucose levels and BMD (Table 2). Afte adjusting fo age and menopausal time, the patial coelation of BMD with biochemical make levels wee shown in Table 3. Discussion Data egading the impact of DM on the BMD ae contovesial. Studies have found that people with type 2 diabetes have inceased, 6~8 simila 4,5 o deceased bone mass Table 2. Analysis of coelation of T scoe femoal neck, T scoe lumba spine Total cholesteol Fasting glucose Estadiol FSH LH Ca Menopause time TSKF TSKV FSH: follicle stimulating homone, LH: luteinizing homone, Ca: calcium, : phosphous, TSKF: T scoe femoal neck, TSKV: T scoe lumba veteba spine Table 3. Analysis of patial coelation of T scoe femoal neck, T scoe lumba spine (afte adjust fo age and menopause time) Total cholesteol Fasting glucose Estadiol FSH LH Ca TSKF TSKV FSH: follicle stimulating homone, LH: luteinizing homone, Ca: calcium, : phosphous, TSKF: T scoe femoal neck, TSKV: T scoe lumba veteba spine 38

4 Emel Kiyak Caglayan, et al. BMD in ostmenopausal Women with DM, HT in compaison to healthy contol subjects. 3 Although BMD measuements of femu neck and lumba (L2-L4) spines wee lowe in study goup. We couldn t find significant diffeences between study and contol goup. Regading the effect of glycaemia on BMD, thee ae some data that depict the elation between glycaemia and BMD. Hypeglycemia induces deceased bone tunove with osteoblast dysfunction and suppesses seum osteocalcin levels. 9,10 Accoding to the pevious studies that defend a elation between DM and osteopoosis, osteopoosis is moe fequent among chonic DM patients, who have etinopathies, neuopathies o vascula disease. 11 Kanazawa et al. 12 claimed a negative coelation between seum osteocalcin and hemoglobin A1c (HbA1c) levels. Viegas et al. 13 found emakable osteopoosis and vetebal factue atios among chonic diabetic postmenopausal women who have etinopathy and enal dysfunction. But thee ae also some studies that claim no elation between DM and osteopoosis. Fo example Anafooglu et al. 14 found no elation between type 2 diabetes and osteopoosis among postmenopausal women but a negative coelation between femoal neck BMD and mico albuminuia due to DM. Othe studies showed that BMD values of type 2 DM patients wee highe than non-diabetic patient s values. 15 Although thee is no consensus about the effects of hypecholesteolemia on BMD, many authos noticed a negative coelation between hypecholesteolemia and BMD. In vito studies, it was shown that lipids and lipopotein oxidation poducts hampeed the functions and diffeentiation of osteoblasts. 16 Low-density lipopoteins (LDL) cholesteol has got diect negative effect on bone metabolism. This negative effect of LDL cholesteol paticles is explained by inceased catabolism athe than bone poduction. 17,18 Similaly, oli et al. 19 found low BMD among 1303 postmenopausal patients who have high plasma LDL levels. Cui et al. 20 epoted a negative coelation between LDL levels and lumbe BMD values in postmenopausal patients. In anothe study lumbe BMD values found lesse among postmenopausal women who have high seum cholesteol and LDL levels. 21 On the othe hand Demi et al. 22 couldn t find any coelation between cholesteol levels and BMD. In anothe study it was epoted that lipid pofile wasn t a unique facto on BMD besides lipids duation of menopause and level of estogen wee also effective on BMD. 23 In ou study we couldn t find significant diffeences between diabetic, hypelipidemic and hypetensive women and contol goup. Thee is expediency with liteatue. In ou study we didn t inquie medication among hypetensive and hypelipidemic patients. In the liteatue positive effects of antihypetensive and antihypelipidemic dugs on BMD wee epoted. Some pevious studies epoted positive effects of anti-lipid dugs on BMD. 24~26 In anothe study Olmos et al. 27 epoted that thiazide goup dugs wee effective in inceasing BMD in hypetensive patients. The elation between BMD and Cadiovascula Disease isk factos such as hypetension and hypelipidemia couldn t be clealy defined. In anothe study, no elation was found between hypetension and BMD. 28,29 Thee ae no significant diffeences between study goup and contol goup in tems of BMD measuements. We found that, accompanying chonic diseases such as diabetes, hypetension and hypelipidemia don t affect the BMD measuements at postmenopausal peiod. So these postmenopausal women don t have excess isk egading osteopoosis. Conflict of Inteest No potential conflict of inteest elevant to this aticle was epoted. Refeences 1. Tuominen JT, Impivaaa O, uukka, Rönnemaa T. Bone mineal density in patients with type 1 and type 2 diabetes. Diabetes Cae 1999; 22: Compston JE, Smith EM, Matthews C, Schofield. Whole body composition and egional bone mass in women with insulin-dependent diabetes mellitus. Clin Endocinol (Oxf) 1994; 41: Nicodemus KK, Folsom AR. Type 1 and type 2 diabetes and incident hip factues in postmenopausal women. Diabetes Cae 2001; 24:

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