What is it about?

We explore bone density and blood markers of bone turnover to try and explain why people with diabetes suffer bone fractures when their bone density appears good. As people with diabetes are usually both more insulin resistant, as well as having higher body fat percentage than people without diabetes, we designed a study to look at the effects of insulin resistance and body fat percentage separately. So we compared the bone density and bone turnover marker levels of people who were lean without diabetes, against three other groups who were all overweight or obese: those who were insulin sensitive without diabetes, insulin resistant without diabetes, and those who had diabetes. We found that bone density was higher in the three overweight groups, but this difference was related to their weight (and lean mass i.e. non-fat or bone mass, in particular). We found that bone turnover marker levels were lower in the insulin resistant groups, related to their insulin levels and the amount of abdominal fat they had. Both insulin levels and abdominal fat are associated with insulin resistance. We think that factors in visceral fat increase insulin resistance, thereby increasing insulin levels, and insulin acts directly on bone to reduce bone turnover.

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Why is it important?

Bone fracture is associated with increased mortality and morbidity (disability). Our current methods for detecting increased risk of bone fracture is by measuring bone density. But bone density underestimates the risk of fracture in those with diabetes. Therefore we need a better way to detect increased fracture risk in diabetes. It may also mean that we need to treat diabetes differently to reduce risk of fracture. Or, that we need to treat fractures in those with diabetes differently.

Perspectives

There is a complex interaction between all our body systems, yet they are often studied separately e.g. diabetes and insulin resistance research and bone research are often done by different people. Understanding the interaction will help people who have disease of either system. This research highlights that overweight or obesity has a different effect on bone health than does insulin resistance and diabetes.

Katherine Tonks

Read the Original

This page is a summary of: Bone Turnover Is Suppressed in Insulin Resistance, Independent of Adiposity, The Journal of Clinical Endocrinology & Metabolism, January 2017, Endocrine Society,
DOI: 10.1210/jc.2016-3282.
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