Bone Mineral Density of Post-Menopausal Diabetic and Non-Diabetic Women from Mumbai City

Dr. Jagmeet Madan, Shiza Khan , Afshan Hussain , Neha Sanwalka , Deepak Patkar

Dr. Jagmeet Madan, Shiza Khan , Afshan Hussain , Neha Sanwalka , Deepak Patkar Professor, Principal, Sir Vithaldas Thackersey College of Home Science (Autonomous) SNDT Women’s University, Mumbai; National Vice President – Indian Diebetic Association.

Keywords: Osteoporosis, Osteopenia, Type 1 diabetes, Type 2 diabetes, T Score, dietary intake

Abstract

Objective: To assess the bone mineral density of type 1 and type 2 diabetic and non-diabetic post-menopausal women.
Methods: A cross-sectional study was conducted in 98 post-menopausal women aged 60.5±6.4 years. The participants comprised of 20 type 1 diabetics, 28 type 2 diabetic women and 50 non diabetic women. Anthropometry and dietary intake was assessed for all participants. T score for bone mineral density was measured by DEXA at lumbar spine, femoral neck and total body. This was used to classify women as suffering from osteoporosis and osteopenia.
Results: The mean weight was significantly higher in type 1 and type 2 diabetics as compared to non-diabetics (p<0.05). Protein and calcium intake was 52-60% of the RDA in diabetics. There was no significant difference in T score at lumbar spine, femoral neck or total body between the 3 groups (p>0.05). After adjusting for weight and nutrient intake, lumbar spine and femoral neck T score was significantly lower in type 1 diabetics (p<0.05). Type 2 diabetics also had significantly lower adjusted femoral neck T score as compared to non-diabetics (p<0.05). Higher percentage of type 2 diabetics (77.8%) and non-diabetics (77.5%) had low bone density (osteopenia + osteoporosis) at lumbar spine as compared to type 1 diabetics (60%). Higher percentage of type 1 diabetics (75%) and type 2 diabetics (82.1%) had low bone density at femoral neck.
Conclusion: A high percentage of postmenopausal women in Mumbai were observed to be osteopenic and osteoporotic. Dietary and lifestyle Intervention programs need to be developed to prevent onset of osteopenia and osteoporosis especially in diabetic post-menopausal women.

Conflict of Interest: None declared.

References

1. J MXi, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015;1(1):9–13.
2. Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646–50.
3. Bonjour JP, Chevalley T, Ferrari S, Rizzoli R. The importance and relevance of peak bone mass in the prevalence of osteoporosis.
Salud Publica Mex. 2009; 51 Suppl 1:S5-17.
4. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006 Feb;194(2 Suppl):S3-11
5. Pai M V. Osteoporosis Prevention and Management. J Obstet Gynecol India. 2017;67(4):237–42.
6. Alswat KA. Gender Disparities in Osteoporosis. J Clin Med Res. 2017;9(5):382–7.
7. Cauley JA. Public health impact of osteoporosis. J Gerontol A Biol Sci Med Sci. 2013;68(10):1243–51.
8. Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA; IOF CSA
Working Group on Fracture Epidemiology. Secular trends in the incidence of hip and other osteoporotic fractures. Vol.
22, Osteoporosis International. Osteoporos Int; 2011. p.1277– 88.
9. Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: An Indian perspective. Osteoporos
Int. 2011 May;22(5):1277-88
10. Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes. Int J Endocrinol. 2014; 2014:820615.
11. Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes - A
meta-analysis. Osteoporos Int. 2007 Apr;18(4):427–44.
12. Dhaon P, Shah V. Type 1 diabetes and osteoporosis: A review of literature. Indian J Endocrinol Metab. 2014;18(2):159.
13. Leidig-Bruckner G, Grobholz S, Bruckner T, Scheidt-Nave C, Nawroth P, Schneider JG. Prevalence and determinants of
osteoporosis in patients with type 1 and type 2 diabetes mellitus. BMC Endocr Disord. 2014 Apr 11;14(1):33.
14. Paschou SAΑ, Dede AD, Anagnostis PG, Vryonidou A, Morganstein D, Goulis DG. Type 2 Diabetes and
Osteoporosis: A Guide to Optimal Management. J Clin Endocrinol Metab. 2017;102(10):3621–34.
15. Karimifar M, Pasha MAP, Salari A, Zamani A, Salesi M, Motaghi P. Evaluation of bone loss in diabetic postmenopausal
women. J Res Med Sci. 2012;17(11):1033–8.
16. Neglia C, Agnello N, Argentiero A, Chitano G, Quarta G, Bortone I, Della Rosa G, Caretto A, Distante A, Colao A, Di
Somma C, Migliore A, Auriemma RS, Piscitelli P. Increased risk of osteoporosis in postmenopausal women with type 2
diabetes mellitus: a three-year longitudinal study with phalangeal QUS measurements. J Biol Regul Homeost Agents.
2014;28(4):733–41.
17. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention
strategies. Lancet. 2004;363(9403):157–63.
18. Meeta, Harinarayan CV, Marwah R, Sahay R, Kalra S BS. Clinical practice guidelines on postmenopausal osteoporosis:
An executive summary and recommendations. J Midlife Health. 2013;4(2):107–26.
19. Gopalan C, Ramasastri BB, Balasubramanyam SC. Nutritive Value of Indian Foods. National Institute of Nutrition, Indian
Council of Medical Research, Hyderabad, India; 2003.
20. A report of the expert group of the Indian Council of Medical Research, Nutrient requirement and recommended dietary
allowances for Indians. 2009. Available from: http://icmr.nic.in/final/RDA-2010.pdf. [Assessed on 1st May 2020].
21. Fellinger P, Fuchs D, Wolf P, Heinze G, Luger A, Krebs M, Winhofer Y. Overweight and obesity in type 1 diabetes equal
those of the general population. Wien Klin Wochenschr. 2019 Feb 1;131(3–4):55–60.
22. Sharma S, Tandon VR, Mahajan A, Kour A, Kumar D. Preliminary screening of osteoporosis and osteopenia in urban
women from Jammu using calcaneal QUS. Indian J Med Sci. 2006;60(5):183–9.
23. Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, Saberwal A, Bhadra K, Mithal A. Bone health
in healthy Indian population aged 50 years and above. Osteoporos Int. 2011;22(11):2829–36.
24. Kadam N, Chiplonkar S, Khadilkar A, Divate U, Khadilkar V. Low bone mass in urban Indian women above 40 years
of age: Prevalence and risk factors. Gynecol Endocrinol. 2010;26(12):909–17.
25. Sharma, Singh H, Chodhary P, Saran S, Mathur SK. Osteoporosis in otherwise healthy patients with type 2 diabetes:
A prospective gender based comparative study. Indian J Endocrinol Metab. 2017;21(4):535.
26. Prakash S, Jatti RS, Ghagane SC, Jali SM, Jali M V. Prevalence of osteoporosis in type 2 diabetes mellitus patients using dual
energy X-ray absorptiometry (DEXA) scan. Int J Osteoporos Metab Disord. 2017;10(2):10–6.
27. Kim KC, Shin DH, Lee SY, Im JA, Lee DC. Relation between obesity and bone mineral density and vertebral fractures
in Korean postmenopausal women. Yonsei Med J. 2010;51(6):857–63.
28. Gonnelli S, Caffarelli C, Nuti R. Obesity and fracture risk. Clin Cases Miner Bone Metab. 2014;11(1):9.
29. Harinarayan C V, Ramalakshmi T. Patterns of dietary calcium intake in south Indian rural, urban and metropolitan city
subjects. J Clin Scien Res. 2015;4(5):143-148
30. Heaney Robert P. Protein and Calcium: Antagonists or Synergists? Am J Clin Nutr . 2002;74(4):609–10.
31. Bonjour JP. Dietary Protein: An Essential Nutrient For Bone Health. J Am Coll Nutr. 2005;1;24:526S-536S.