Higher BMD linked to higher risk of progression of individuals with normal blood sugar to prediabetes

Diabetes appears to exhibit a complex relationship with bone health. Cross-sectional studies have revealed lower BMD in type 1 diabetes (T1D) patients but similar or higher BMD in those having type 2 diabetes (T2D) compared with healthy control subjects. In one study, the mean BMD in T2D patients was 10% higher than that of age-matched people without diabetes.

Given the unclarity between prediabetes and bone mineral density, Zhao Liu, University of Tennessee Health Science Center, Memphis, TN, United States, and colleagues in the post-hoc analysis of the POP-ABC study, examined the association between BMD at enrollment and incident prediabetes risk. The team further assessed the relationship between BMD and various glucoregulatory, biochemical, and demographic variables to explore potential mechanisms for any association between bone mineral density and prediabetes.

During 5-years of follow-up, the team analyzed BMD among the initially normoglycemic participants in the POP-ABC (Pathobiology of Prediabetes in a Biracial Cohort) study concerning incident prediabetes.

The study led to the following findings:

• Three hundred forty-three participants underwent DEXA during Year 1 of POP-ABC and were followed quarterly for five years. The mean age was 44.2 years; BMI was 30.2 kg/m2.
• At baseline, the mean BMD was 1.176 ± 0.135 g/cm2 (1.230 ± 0.124 g/cm2 in men versus 1.154 ± 0.134 g/cm2 in women).
• During five years of follow-up, 101 participants developed prediabetes; ten subjects produced T2DM (progressors); 232 were nonprogressors. Progressors to prediabetes had numerically higher baseline BMD and experienced a lower 1-year decline in BMD than nonprogressors.
• From Kaplan-Meier analysis, the time to 50% prediabetes survival was 2.15 y among participants in the lowest quartile of baseline BMD, longer than those in higher quartiles (1.31 - 1.41 y).
• Values for BMD correlated inversely with age and adiponectin levels and positively with BMI.
• In logistic regression analysis, BMD z score significantly predicted incident prediabetes: more negative BMD z scores were associated with decreased incident prediabetes (odds ratio 0.598) after controlling for age, BMI, change in BMI, ethnicity, blood glucose and adiponectin.

"In our prospective study of healthy offspring of T2D parents, bone density at enrollment had the expected relationships with sex, age, and ethnicity," the researchers wrote. "Subjects who developed prediabetes during five years tended to have a higher baseline bone mineral content (BMC) and BMD and showed a significantly slower decline in BMD for one year than nonprogressors."

"Higher bone mass predicted increased 5-year risk of progression to prediabetes from normoglycemia," they conclude. These findings indicate an inverse relationship between baseline bone mass and incident prediabetes risk."

Thus, our findings suggest that BMD might be a biomarker for incident glycemic deterioration among normoglycemic individuals, said researchers.

Reference:

Liu, Z., Asuzu, P., Patel, A., & Wan, J. (2023). Association of bone mineral density with prediabetes risk among African-American and European-American adult offspring of parents with type 2 diabetes. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.1065527