Entity

Time filter

Source Type


Zhukouskaya V.V.,Units of Endocrinology and Metabolic Diseases | Zhukouskaya V.V.,University of Milan | Eller-Vainicher C.,Units of Endocrinology and Metabolic Diseases | Gaudio A.,University of Catania | And 18 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: In type 2 diabetes (T2D), the vertebral fracture (VFx) prevalence and cortisol secretion are increased. Objective: The objective of this study was to evaluate the role of glucocorticoid secretion and sensitivity in T2D-related osteoporosis. Design and Setting: This was a case-control study in an outpatient setting. Patients: The patients were ninety-nine well-compensated T2D postmenopausal women (age, 65.7 ± 7.3 y) and 107 controls (age, 64.5 ± 8.2 y). Main Outcome Measures: We assessed osteocalcin, C-terminal telopeptide of type I collagen, ACTH, cortisol after the dexamethasone suppression test (F-1mgDST), BclI and N363S single-nucleotide polymorphisms (SNPs) of glucocorticoid receptor, lumbar spine and femoral neck bone mineral density by dual x-ray absorptiometry, and VFx by radiography. Results: Comparedwith controls, T2Dsubjectshadincreased VFx prevalence (20 vs 34.3%, respectively; P =.031), bone mineral density (Z-scores, lumbar spine, 0.16 ± 1.28 vs 0.78 ± 1.43, P =.001; femoral neck, -0.03 ± 0.87 vs 0.32 ± 0.98, P =.008, respectively), and F-1mgDST (1.06 ± 0.42 vs 1.21 ± 0.44 ±g/dL, 29.2 ± 1.2 vs 33.3 ± 1.2 nmol/L, respectively; P =.01), and decreased osteocalcin (10.6 ± 6.4 vs 4.9±3.2 μg/mL, 10.6±6.4 vs 4.9±3.2±g/L, respectively; P<.0001) and C-terminal telopeptide of type I collagen (0.28±0.12 vs 0.14±0.08 ng/mL, 0.28±0.12 vs 0.14±0.08 mcg/L, respectively; P<.0001). Fractured controls or T2D patients had increased sensitizing N363S SNP prevalence (20 and 17.6%, respectively) compared to non-fractured subjects (3.4 and 3.1%, respectively; P =.02 for both comparisons), and similar BclI SNP prevalence. The VFx presence was associated with the sensitizing variant of N363S SNPs in controls (odds ratio [OR]=10.6; 95% confidence interval [CI], 1.8-63.3; P=.01) and in T2D patients (OR = 12.5; 95% CI, 1.8-88.7; P =.01), and with the F-1mgDST levels (OR = 2.1; 95% CI, 1.1-4.1; P =.03) only in T2D patients. Conclusions: In postmenopausal T2D women, VFx are associated with cortisol secretion and the sensitizing variant of N363S SNPs. Copyright © 2015 by the Endocrine Society.


Zhukouskaya V.V.,Units of Endocrinology and Metabolic Diseases | Zhukouskaya V.V.,University of Milan | Ellen-Vainicher C.,Units of Endocrinology and Metabolic Diseases | Ellen-Vainicher C.,University of Milan | And 19 more authors.
Osteoporosis International | Year: 2016

Summary: The objective of the study was to evaluate the usefulness of trabecular bone score (TBS) and bone mineral density (BMD) for identifying vertebral fractures (VFx) in well-compensated type 2 diabetic (T2D) patients. TBS and femoral neck BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients. Introduction: In T2D, the prevalence of VFx is increased, especially in poorly compensated and complicated diabetic patients. The possibility of predicting the fracture risk in T2D patients by measuring BMD and TBS, an indirect parameter of bone quality, is under debate. Therefore, the objective was to evaluate the usefulness of TBS and BMD for identifying VFx in well-compensated T2D patients. Methods: Ninety-nine T2D postmenopausal women in good metabolic control (glycosylated haemoglobin 6.8 ± 0.7 %) and 107 control subjects without T2D were evaluated. In all subjects, we evaluated the following: the BMD at the lumbar spine (LS) and the femoral neck (FN); the TBS by dual X-ray absorptiometry; and VFx by radiography. In T2D subjects, the presence of diabetic retinopathy, neuropathy, and nephropathy was evaluated. Results: T2D subjects had increased VFx prevalence (34.3 %) as compared to controls (18.7 %) (p = 0.01). T2D subjects presented higher BMD (LS −0.8 ± 1.44, FN −1.06 ± 1.08), as compared to controls (LS −1.39 ± 1.28, p = 0.002; FN −1.45 ± 0.91, p = 0.006, respectively). TBS was not different between diabetics and controls. In fractured T2D patients, LS-BMD, FN-BMD, and TBS were reduced (−1.2 ± 1.44; −1.44 ± 1.04; 1.072 ± 0.15) and the prevalence of retinopathy (15.4 %) was increased than in nonfractured T2D subjects (−0.59 ± 1.4, p = 0.035; −0.87 ± 1.05, p = 0.005; 1.159 ± 0.15, p = 0.006; 1.8 %, p = 0.04, respectively). The combination of TBS ≤1.130 and FN-BMD less than −1.0 had the best diagnostic accuracy for detecting T2D fractured patients (SP 73.8 %, SN 63.6 %, NPV 78.9 %, PPV 56.8 %). Conclusions: TBS and FN-BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation.

Discover hidden collaborations