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Obese diabetics had low vitamin D and spine fractures – June 2013

Spinal deformity index in patients with type 2 diabetes.

Endocrine. 2013 Jun;43(3):651-8. doi: 10.1007/s12020-012-9848-z. Epub 2012 Dec 11.
Di Somma C, Rubino M, Faggiano A, Vuolo L, Contaldi P, Tafuri N, Andretti M, Savastano S, Colao A.
SDN Foundation Naples, Naples, Italy. cdisomma at unina.it

The objective of this study is to investigate bone metabolism, density, and quality in patients with diabetes type 2 using DEXA and spinal deformity index (SDI), a surrogate index of bone quality. Fifty-six patients with type 2 diabetes were studied; exclusion criteria were diseases and medications that affect bone and mineral metabolism.

  • Mean age was 65 ± 7 years.
  • Mean diabetes duration was 10 ± 7 years and
  • mean HbA1C was 6.6 ± 0.5 %.
  • BMI was 30 ± 4. (VitaminDWiki comment = Obese)

Fifty-six sex, age, and BMI matched served as controls. All subjects underwent a clinical and biochemical examination. Spinal and femoral neck BMD were measured by DEXA, and a spine radiography was performed to assess vertebral fractures and to calculate SDI.
Mean serum 25-OH vitamin D levels were

  • 19.6 ± 3.7 ng/ml in patients and
  • 30 ± 14 ng/ml in controls (p < 0.01).

PTH serum levels were 47.9 ± 40 pg/ml in patients versus 37 ± 5.3 pg/ml in controls (p < 0.01). At lumbar spine there was a significant difference between patients and controls only for T-score (p = <0.01), while at femoral neck there was a difference in BMD (p < 0.01) and in T-score (p < 0.01).
Radiological vertebral fractures were found in

  • 46 % of patients and
  • 17 % of controls (p < 0.05).

SDI was higher in patients than in controls (p < 0.05).
The percentage of fractures with T-score BMD greater than -2.5 was 69 % in patients and 10 % in controls (p < 0.05).
As a conclusion, BMD was similar in patients and in controls, while SDI value was higher in patients; therefore, SDI was more specific than BMD for the diagnosis of osteoporosis due to metabolic diseases.

Comment in: Type 2 diabetes and fractures: more information is needed. [Endocrine. 2013]
PMID: 23229683

See also VitaminDWiki