Hemoglobin A1c Threshold for Reduction in Bone Turnover in Men With Type 2 Diabetes Mellitus

Authors

Sabaa Joad
Elliot Ballato
Fnu Deepika
Giulia Gregori
Alcibiades Leonardo Fleires-Gutierrez
Georgia Colleluori
Lina Aguirre
Rui Chen
Vittoria Russo
Virginia Carolina Fuenmayor Lopez
Clifford Qualls
Dennis T Villareal
Reina Armamento-Villareal

Publication Date

1-1-2021

Journal

Frontiers in Endocrinology

DOI

10.3389/fendo.2021.788107

PMID

35027909

PMCID

PMC8750620

PubMedCentral® Posted Date

12-18-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Absorptiometry, Photon, Adult, Aged, Biomarkers, Bone Density, Bone Remodeling, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypogonadism, Male, Middle Aged, Hemoglobin A1c, type 2 diabetes mellitus, bone turnover markers, CTX, osteocalcin

Abstract

BACKGROUND: Emerging data suggest that type 2 diabetes mellitus (T2D) is associated with an increased risk for fractures despite relatively normal or increased bone mineral density (BMD). Although the mechanism for bone fragility in T2D patients is multifactorial, whether glycemic control is important in generating this impairment in bone metabolism remains unclear. The purpose of our study is to identify a hemoglobin A1c (A1c) threshold level by which reduction in bone turnover begins in men with T2D.

METHOD: A cross-sectional analysis of baseline data was obtained from 217 men, ages 35-65, regardless of the presence or absence of hypogonadism or T2D, who participated in 2 clinical trials. The following data were obtained: A1c by HPLC, testosterone and estradiol by LC/MS, bone turnover markers Osteocalcin [OC], C-terminal telopeptide [CTx], and sclerostin by ELISA, and BMD by DXA. Patients were grouped into 4 categories based of A1c (group I:

RESULTS: Threshold model and nonlinear regression showed an A1c cut-off of 7.0, among all choices of A1cs, yields the least sum of squared errors. A comparison of bone turnover markers revealed relatively lower OC (p = 0.002) and CTx (p = 0.0002) in group IV (A1c ≥7%), compared to the other groups. An analysis of men with T2D (n = 94) showed relatively lower OC (p=0.001) and CTx (p=0.002) in those with A1c ≥7% compared to those with

CONCLUSION: An analysis across our entire study population showed a breakpoint A1c level of 7% or greater is associated with lower bone turnover. Also in men with T2D, an A1c ≥7% is associated with low bone turnover.

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