MECHANISMS IN ENDOCRINOLOGY: Diabetes mellitus, a state of low bone turnover - a systematic review and meta-analysis.

Abstract

OBJECTIVE:

To investigate the differences in bone turnover between diabetic patients and controls.

DESIGN:

A systematic review and meta-analysis.

METHODS:

A literature search was conducted using the databases Medline at PubMed and EMBASE. The free text search terms 'diabetes mellitus' and 'bone turnover', 'sclerostin', 'RANKL', 'osteoprotegerin', 'tartrate-resistant acid' and 'TRAP' were used. Studies were eligible if they investigated bone turnover markers in patients with diabetes compared with controls. Data were extracted by two reviewers.

RESULTS:

A total of 2881 papers were identified of which 66 studies were included. Serum levels of the bone resorption marker C-terminal cross-linked telopeptide (-0.10 ng/mL (-0.12, -0.08)) and the bone formation markers osteocalcin (-2.51 ng/mL (-3.01, -2.01)) and procollagen type 1 amino terminal propeptide (-10.80 ng/mL (-12.83, -8.77)) were all lower in patients with diabetes compared with controls. Furthermore, s-tartrate-resistant acid phosphatase was decreased in patients with type 2 diabetes (-0.31 U/L (-0.56, -0.05)) compared with controls. S-sclerostin was significantly higher in patients with type 2 diabetes (14.92 pmol/L (3.12, 26.72)) and patients with type 1 diabetes (3.24 pmol/L (1.52, 4.96)) compared with controls. Also, s-osteoprotegerin was increased among patients with diabetes compared with controls (2.67 pmol/L (0.21, 5.14)).

CONCLUSIONS:

Markers of both bone formation and bone resorption are decreased in patients with diabetes. This suggests that diabetes mellitus is a state of low bone turnover, which in turn may lead to more fragile bone. Altered levels of sclerostin and osteoprotegerin may be responsible for this.

• Authors: Katrine Hygum, Jakob Starup-Linde, Torben Harsløf, Peter Vestergaard, Bente L Langdahl
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 176 Issue 3 Pg. R137-R157 (Mar 2017) ISSN: 1479-683X [Electronic] England
• PMID: 28049653 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2017 European Society of Endocrinology.

Chemical References

• Adaptor Proteins, Signal Transducing
• Biomarkers
• Bone Morphogenetic Proteins
• C-terminal cross-linking telopeptide of type II collagen, human
• Collagen Type II
• Genetic Markers
• Osteoprotegerin
• Peptide Fragments
• Procollagen
• SOST protein, human
• procollagen Type I N-terminal peptide
• Osteocalcin
• Tartrate-Resistant Acid Phosphatase

Topics

• Adaptor Proteins, Signal Transducing
• Biomarkers (blood)
• Bone Morphogenetic Proteins (blood)
• Bone Remodeling (physiology)
• Case-Control Studies
• Collagen Type II (blood)
• Diabetes Mellitus, Type 1 (blood, physiopathology)
• Diabetes Mellitus, Type 2 (blood, physiopathology)
• Genetic Markers
• Humans
• Osteocalcin (blood)
• Osteoprotegerin (blood)
• Peptide Fragments (blood)
• Procollagen (blood)
• Tartrate-Resistant Acid Phosphatase (blood)