الفهرس Only 14 pages are availabe for public view
 |  | from | 106 |  |  |
| | | from | 106 | | |
Abstract
Introduction:
Diabetic osteopenia is a recognized complication of diabetes mellitus. Several pathogenic mechanisms have been proposed including poor glycemic control, disturbances in mineral or vitamin D metabolism, defects in insulin like growth factor system, abnormal parathyroid function and chronic vascular diseases of bone. Yet the effect of type 2 diabetes on bone mineral density is variable at different skeletal sites.
Aim of the study:
The aim of the present work was to study the effect of type 2 diabetes on bone mineral density at different skeletal sites, and its relation to duration of diabetes, glycaemic control and some minerals. The study was carried out on thirty type 2 male diabetic patients who regularly visited the outpatient clinic at Sharq el madina hospital, with diabetes diagnosed after the age of thirty. Fifteen healthy subjects with comparable age and sex were also included as a control group. Patients with age above fifty five were excluded, also patients with disorders affecting bone metabolism were excluded from study.
Subjects:
All patients and controls were subjected to full history taking, complete clinical examination and laboratory investigations including fasting plasma glucose, postprandial plasma glucose, HbA1c, serum calcium, serum phosphorous and serum alkaline phosphatase. Assessment of bone mineral density was done for patients and controls by DEXA over lumbar spine, left radius, and left femur.
Methods:
All patients and controls included in the study were subjected to the following after taking an informed consent:
Full history taking, complete clinical examination and laboratory investigations including fasting plasma glucose, postprandial plasma glucose, HbA1c, serum calcium, serum phosphorous and serum alkaline phosphatase. Assessment of bone mineral density was done for patients and controls by DEXA over lumbar spine, left radius, and left femur.
Results:
The results of this work showed that bone mineral density of lumbar spine is significantly deceased among diabetic patients than controls in comparison with age matched or young adults, indicating that type 2 DM reduces bone mineral density at that site.
Bone mineral density of neck of femur was found to be significantly decreased in diabetic patients than controls in comparison with age matched or young adults, indicating that type 2 DM reduces bone mineral density at that site.
Bone mineral density of total femur was found to be unchanged between diabetic patients and controls. No significant difference was found in bone mineral density of total left radius between diabetic patients and controls. No significant difference in serum calcium, serum phosphorous or serum total alkaline phosphatase was found between diabetic patients and controls.
Duration of diabetes was negatively correlated with bone mineral density of lumbar spine, total femur, neck of femur and total radius of diabetic patients, indicating the negative effect of the duration of type 2 DM on bone mineral density.
Fasting plasma glucose, postprandial plasma glucose or HbA1c were found to be not correlated with any changes in bone mineral density of diabetic patients at any studied site.
Serum calcium, serum phosphorous and serum total alkaline phosphatase were found to be not correlated with any changes in bone mineral density of diabetic patients at any studied site.
Body weight and height were positively correlated with bone mineral density of lumbar spine and radius of diabetic patients.
Fracture risk at lumbar spine was significantly higher among diabetic patients than controls, indicating the effect of type 2 DM on fracture risk at that site.
Fracture risk at neck of femur was significantly higher among diabetic patients than controls, indicating the effect of type 2 DM on fracture risk at that site.
Duration of diabetes was positively correlated with fracture risk of lumbar spine, indicating the increased fracture risk among type 2 diabetic patients with longer duration of diabetes. Body weight was positively correlated with fracture risk of spine. No significant correlation was found between peripheral neuropathy and fracture risk of bone in type 2 diabetic patients.
Conclusion:
from the present study one can deduce that type 2 DM is associated with decreased bone mineral density in lumbar spine and neck of femur. This is related to longer duration of diabetes. Diabetic patients are more subjected to fracture at lumbar spine and fracture at neck of femur that is related to longer duration of diabetes. Bone mineral density at radius and over total femur is not changed in type 2 diabetic patients. Diabetic complications (peripheral neuropathy) are not related to fracture risk in type 2 diabetic patients.