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[Microalbuminuria as a risk factor for diabetic osteopathy in patients with IDDM and renal sufficiency]
E Goliat1, W Marusza, K Ostrowski
1Katedra i Klinika Chorób Wewnetrznych i Nefrologii Akademii Medycznej w Warszawie.
Abstract:
Disturbances in bone marrow vascularisation can be one of the causes of diabetic osteopathy. The aim of the study was to answers the question if microalbuminuria as a results of capillary injury can be a sign of bone mineralisation disorders in IDDM renal sufficient patients. We examined 60 IDDM patients (30 women without menstruation disturbances; 30 men; age 25-36 years old). All the observed subjects were divided into groups: I-30 normoalbuminuric patients (0-29 mg/24 h); II-30 microabuminuric patients (30-295 mg/24 h). Bone mineral density (BMD) of femoral neck, lumbar spine (L2-L4) and total body was measured by dual energy X-ray absorptiometry (DEXA, Lunar). The biochemical parameters of bone turnover were measured both in serum and urine as follows: osteocalcine, total hydroxyproline (HPR, HPR/Cr), total alkaline phosphatase (AP) with bone fraction, total calcium (Ca, Ca/Cr) and inorganic phosphor (P). Microalbuminuric patients presented more severe bone turnover disturbances, shown by differences in: BMD and Z-score for femoral neck (p < 0.05), serum HPR (p < 0.05), AP (p < 0.05), AP (p < 0.01) and its bone fraction (p < 0.05). We proved the presence of statistically significant correlation coefficients for albuminuria and some densytometric and biochemical bone parameeters. Our results suggest that microalbuminuria can indirectly indicate the dynamic of bone turnover derangement in IDDM course. They are present mostly in the femoral neck, which because of the vascularisation type is particularly susceptible to subalimentation in the diabetic microangiopathy course.
Insights
Microalbuminuria, an indicator of capillary injury in patients with type 1 diabetes, may signal bone mineralization disorders. This suggests microalbuminuria can indirectly reflect bone turnover issues, particularly in the femoral neck.
Area of Science:
- Endocrinology
- Nephrology
- Orthopedics
Background:
- Diabetic osteopathy is linked to impaired bone marrow vascularization.
- Microalbuminuria, resulting from capillary injury, may indicate broader microvascular complications in diabetes.
Purpose of the Study:
- To investigate if microalbuminuria is associated with bone mineralization disorders in patients with insulin-dependent diabetes mellitus (IDDM).
- To determine if microalbuminuria can serve as an early marker for bone turnover derangements in renal-sufficient IDDM patients.
Main Methods:
- Sixty IDDM patients were divided into normoalbuminuric and microalbuminuric groups.
- Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry (DEXA).
- Biochemical markers of bone turnover (osteocalcin, hydroxyproline, alkaline phosphatase, calcium, phosphorus) were measured in serum and urine.
Main Results:
- Microalbuminuric patients exhibited more significant bone turnover disturbances.
- Statistically significant differences were observed in BMD and Z-score for the femoral neck, serum hydroxyproline, and alkaline phosphatase levels in microalbuminuric patients.
- Significant correlations were found between albuminuria and specific bone densitometric and biochemical parameters.
Conclusions:
- Microalbuminuria may indirectly indicate dynamic bone turnover derangements in IDDM.
- Bone metabolism disturbances are particularly noted in the femoral neck, a site vulnerable to diabetic microangiopathy-related vascular compromise.