The Paradoxical Relationship Among Diabetes Mellitus, Osteoporosis and Sarcopenia: The PARADOS Study

Type 2 diabetes mellitus (DM), osteoporosis (OP) and sarcopenia are major public health problems related with higher fall/fracture risks, morbidity and mortality. Due to the lack of a comprehensive analysis among OP, sarcopenia and DM; we aimed to explore the relationships between DM and the aforementioned conditions in postmenopausal women.

This cross-sectional study included postmenopausal women who consecutively admitted to the Departments of Physical & Rehabilitation Medicine, and Endocrinology and Metabolism. Demographic data, nutrition/cognition status and frailty scores of the participants were recorded. Sarcopenia-related parameters including, anterior thigh muscle thickness, handgrip strength, chair stand test, gait speed, and one-leg stand test (OLST) were measured. ISarcoPRM algorithm was used for the diagnosis of sarcopenia.

A total of 444 postmenopausal women were consecutively enrolled. DM patients (N = 158) had higher frequency of sarcopenia (23.4 % vs. 12.9 %), but lower frequency of OP (33.5 % vs. 50.7 %) than controls (both p < 0.01). As regards regression analyses; menopause duration was positively (OR: 1.054, 95 % CI 1.030-1.077), but weight (OR: 0.957, 95 % CI 0.940-0.975) and DM (OR: 0.477, 95 % CI 0.310-0.733) were negatively related with OP (all p < 0.001). On the other hand, age (OR: 1.094, 95 % CI 1.056-1.133), body mass index (OR: 1.131, 95 % CI 1.067-1.198), and DM (OR: 1.887, 95 % CI 1.107-3.218) were positively related with sarcopenia (all p < 0.05). In addition, age (β = -0.355, p < 0.001), body mass index (β = -0.108, p = 0.021) and DM (β = -0.209, p < 0.001) were negatively related with OLST values.

DM has paradoxical associations with bone mass and muscle mass/function. Although it has negative relationship with OP (about two times lower odds), it has positive relationship with sarcopenia (about two times higher odds).