INDEPENDENT AND COMBINED EFFECTS OF HYPERGLYCEMIA AND CHRONIC KIDNEY DISEASE ON BONE MINERAL DENSITY AND...

Abnormal glucose metabolism (prediabetes and type 2 diabetes mellitus [T2DM]) and chronic kidney disease (CKD) are two conditions that frequently coexist and affect bone mass and microarchitecture. We investigated both independent and combined effects of abnormal glucose metabolism and chronic kidney disease (CKD) on bone mineral density (BMD) and microarchitecture.

This observational, single center, prospective study recruited 604 men and postmenopausal women with prediabetes or T2DM and normal kidney function (n=365) or CKD (n=113) or with normal glucose tolerance (NGT) and normal kidney function (n=105) or CKD (n=21). We measured lumbar spine, femoral neck, 33% radius BMD and trabecular bone score (TBS). 25- hydroxyhydroxy-vitamin-D was sufficient in most patients (64.9%). Patients with T2DM were controlled on therapy (glycated hemoglobin 6.3% [5.8-6.6]).

Absolute BMD and T-score were significantly higher in prediabetes and T2DM than in NGT patients at all three sites. Irrespective of glycemic status, patients with CKD had similar BMD with patients with normal kidney function at all sites, even if they were 4-7 years older. TBS was similar in all groups. There was no association between HbA1c and BMD at any site or TBS.

In conclusion, our study showed that impaired glucose metabolism (prediabetes or T2DM) and CKD have independent but no additive effects on bone mineral density and microarchitecture in patients with well-controlled diabetes and vitamin D sufficiency. This suggests that independent intensive treatment and screening could prevent bone loss and architectural damage in these 2 conditions that frequently coexist.