Bone loss and environmental factors in heterosexual partners

Abstracts / Bone 44 (2009) S339–S450

P375 Bone mineral density and bone turnover markers in type 1 diabetic patients A.P. Shepelkevicha,*, V.V. Zhukouskayab, V.L. Lukashevichc, V.G. Kravchukd, J.V. Tolkacheve a Belarusia State Medical University, Minsk, Belarus b Endocrinology, Minsk-city Out-patient's Clinic 32, Minsk, Belarus c Endocrinology, Minsk-city Endocrinological Centre, Minsk, Belarus d Endocrinology, Republic Medical Rehabilitation and Balneotreatment Centre, Minsk, Belarus e Endocrinology, Republic Clinical Hospital of Medical Rehabilitation, Minsk, Belarus Background/aims: A high prevalence of osteopenia in type 1 diabetic patients has been reported, but its underlying causes are still obscure. A lot of factors may contribute to type 1 diabetes-associated bone mass loss, including altered bone mineral metabolism. Therefore the aim of our study was to assess the bone mineral density and bone markers in type 1 diabetic patients. Materials and methods: We examined 291 type 1 diabetic patients (183 women and 108 men) (mean age—34.38 + 10.6 yrs, duration of diabetes mellitus—13.25 + 8.99 yrs, age of manifestation —20.96 ± 10.23 yrs). BMD was measured at spine (L2–L4) and femoral neck in 269 patients using DEXA. Markers of bone formation (serum alkaline phosphatase (ALP), serum N-MID osteocalcin (OC) and bone resorption (cross-linked C-telopeptide (CTX) were measured in 34 diabetics. All the findings were compared in 71 normal age-, sex- and body mass index-matched control subjects. Results: BMD was statistically lower in diabetic patients both at spine (1.09 ± 0.14 vs. 1.23 ± 0.088 g/cm2, р < 0,01) and at femoral neck (0.86 ± 0.13 vs. 1.088 ± 0.14 g/cm2, р < 0,01) in comparison with control, with a stronger degree of manifestation at femoral neck than at spine (0.86 ± 0.13 vs. 1.07 ± 0.14 g/cm2, р < 0.01). The serum levels of markers of bone formation were significantly lower in diabetic patients than in control: ALP (104.07 ± 42.95 vs. 114.18 ± 14.42 U/l, р = 0.00024) and OC (17.3 ± 7.15 vs. 23.44 ±9.34 ng/ml, р = 0.002). The serum level of bone resorption was higher in diabetic patients than in control: CTX (1.06 ± 0.33 vs. 0.7 ± 0.29 pg/ml, р = 0.000017). Conclusions: The bone mass loss in type 1 diabetic patients has been confirmed, predominantly at the femoral neck. A lowered bone formation with the predominance of bone resorption over formation has been demonstrated as one of the mechanisms of the bone density loss in type 1 diabetes mellitus. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.287

P376 Bone mineral density in type 2 diabetic patients A.P. Shepelkevicha,*, E.G. Reunovab, E.V. Rudenkoc, N.A. Vasilievad, O.V. Baranovad a Department of Endocrinology, Belarusian State Medical University, Minsk, Belarus b Minsk-city Out-patient Clinic N25, Minsk, Belarus c Department of Geriatrics and Gerontology, Belarusian Postgraduate Medical Academy, Minsk, Belarus d Republic Center of Medical Rehabilitation and Balneotherapy, Minsk, Belarus Background/aims: There is evidence that patients with type 2 diabetes have an increased risk of certain types of osteoporotic fractures. Widely discussed an association between bone mineral density (BMD) and type 2 diabetes mellitus (DM). The aim of the study was to assess the BMD in type 2 diabetic patients (postmenopausal women and men older 50 years).

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Materials and methods: 132 type 2 diabetic patients (110 postmenopausal women and 22 men older 50 years) (mean age: 61.44 ± 7.31 yrs, duration of DM: 10.57 ± 6.34 yrs, age of manifestation: 50.53 ± 8.68 yrs, BMI: 30.97 ± 4.65, HbA1c: 9.4 ± 1.8%) were examined. BMD was measured by DEXA at spine (L1–L4) and femur. WHO criteria T-score less −2.5 was used for osteoporosis diagnostic. All findings were compared with normal age-, sex- and body mass index-matched control subjects. Results: BMD (g/cm2) was statistically lower in diabetic patients both at spine (1.104 ± 0.188 vs 1.289 ± 0.104 p < 0.05) and at femoral neck (0.87 ± 0.155 vs 1.107 ± 0.112 p < 0.01) in comparison with controls. There is a stronger degree of bone loss manifestation at femoral neck than at spine (0.87± 0.155 vs 1.104 ± 0.188 p < 0.05). Osteopenia in spine was revealed in 34.09% (1.089 ± 0.178 g/cm2); in femoral neck — 40.15% (0.892 ± 0.140 g/cm2); total hip — 22.72% (1.040 ± 0.169 g/cm2); osteoporosis in spine — 15.91% (1.059 ± 0.172 g/cm2); in femoral neck — 9.84% (0.851 ± 0.157 g/cm2); total hip — 3.03% (0.874 ± 0.195 g/cm2). Conclusions: The data confirmed the high prevalence of bone loss in type 2 DM postmenopausal women (at spine — 51.81%, at femoral neck — 51.81%) and men older 50 years (at spine — 31.81%, at femoral neck — 22.72%). The bone mass loss was revealed predominantly at the femoral neck. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.288

P377 Bone loss and environmental factors in heterosexual partners A. Ostertaga,*, M. Cohen-Solala, Y. Madecb, C. Baudoina, M.C. De Vernejoula a U606, INSERM, France b Epidemiologie des Maladies Emergentes, Institut Pasteur, Paris, France Background/aims: Most bone mineral density (BMD) familial resemblance studies assess the role of genetic factors in osteoporosis, but few have studied the relationship of bone loss within wife– husband pairs. The aim of the present study was to determine whether or not bone loss was the same within heterosexual partners who shared the same environment for many decades. Methods: From the longitudinal cohort VIGGOS, which included 139 pairs of husbands and postmenopausal wives, 104 couples who came at least twice and had > 1 year of follow-up were selected for our study. The mean (± SD) age of wives was 63 (± 5) years and that of their husbands was 66 (± 5) years. They had been living together for 40 (± 8) years, and their follow-up was 5 (± 3) years. BMD of the hip was evaluated by DEXA at each of the 4 (± 2) visits. At baseline, lifestyle characteristics (current nutritional habits, smoking, daily physical activity) were assessed using structured questionnaires, and biological and clinical parameters. Intra-couple correlations of baseline parameters were assessed by Pearson's correlation tests. For each gender independently, bone loss at the femoral neck (FN) was estimated as the slope resulting from a mixed-effects linear model where BMD was a function of the time, adjusted for height and weight. For women, BMD was also adjusted for hormonal replacement therapy (HRT). This model took into account the dependent data gathered over time on the same individuals. The intra-couple correlation of bone loss using the Pearson's correlation test was also evaluated. Results: Most of the environmental baseline factors were highly correlated within wife–husband pairs: age (r = 0.70, p < 0.0001), BMI (r = 0.26, p < 0.01), 25-OHD serum level (r = 0.32, p < 0.01), daily calories (r = 0.52, p < 0.001) and calcium intake (r = 0.31, p < 0.01), and physical activity (r = 0.43, p < 0.0001). In contrast, the baseline

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Abstracts / Bone 44 (2009) S339–S450

BMD at FN was not correlated (r = 0.03, p = 0.79). Bone loss was seen in wives (−0.0023 g/cm2/yr, p < 0.01), while it was not seen in their husbands (0.0016 g/cm2/yr, p = 0.10). Bone loss was not correlated within wife–husband pairs (r = 0.0004, p = 0.99). Conclusion: Couples who lived together for 40 years shared lifestyle and environmental factors. However, bone loss was not correlated within couples even when HRT was taken into account in women. Environmental factors do not appear to influence bone loss in the same manner in subjects of different genders and genetic background. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.289

P378 Bone mineral density and periodontal status in type 2 diabetes mellitus women A.N. Yurchuka,*, A.P. Shepelkevichb, N.A. Vasilievac, O.V. Baranovac a 1st Department of Restorative Dentistry, Minsk, Belarus b 1st Department of Internal Medicine, Belarusian State Medical University, Minsk, Belarus c Section of Densitometry, Republican Center of Rehabilitation and Balneotherapy, Minsk, Belarus Background and aim: Osteoporosis and diabetes mellitus are known to be associated with chronic periodontitis. The combined influence of type 2 diabetes mellitus (DM) and systemic changes of bone tissue on the developing of chronic periodontitis are rarely published in periodicals. The aim of the study was to assess interrelations between destructive changes in periodontal tissues and bone mineral density in postmenopausal women with type 2 DM. Materials and methods: 40 type 2 DM women with mean age of 58.73 ± 5.32 years were examined. The durations of diabetes and menopause were 12.35 ± 5.51 and 11.03 ± 7.60 years respectively; HbA1c was 9.75 ± 1.47%. The control group consisted of 15 age and menopause duration match postmenopausal women. Clinical survey consisted of 2 parts: the clinical examination of patients including determination of BMD by DEXA and complex dental assessment including OHI-S, GI, PBI, PBIgr, CPITN, CLA, and assessment of the number of functioning teeth. Results: Women with type 2 DM have negative correlation between lumbar spine BMD (L1–L4) and with the number of sextants with grade 2 in CPITN (r = − 0.37, р < 0.05). There was also relation assessed between BMD L4 and number of CLA = 2 (r = − 0.39, p < 0.05). There were no correlations between BMD and periodontal status in control group. There was correlation observed between BMD of proximal part of the thigh and the number of functioning teeth (r = − 0.81, р < 0.05). Conclusion: The results revealed the interrelations between massive destructive changes in periodontal tissues in postmenopausal women with type 2 diabetes mellitus and bone loss in lumbar spine. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.290

P379 Normal masticatory function protects the rat mandibular bone from estrogen-deficiency induced osteoporosis A. Mavropoulosa,b,*, R. Rizzolic, P. Ammannc a Division of Bone Diseases, Department of Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland b Department of Orthodontics, University of Geneva, Geneva, Switzerland c Division of Bone Diseases, Department of Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland

Background/aim: In a previous investigation we showed that mandibular alveolar (trabecular) bone appears to be less sensitive to protein undernutrition and/or estrogen deprivation than the proximal tibia spongiosa. We hypothesized that the mechanical loading of the alveolar process during mastication may protect the alveolar bone from the detrimental effects of nutritional or hormonal changes observed in other skeletal sites. In order to test this hypothesis we compared the effect of ovariectomy and of protein undernutrition on the mandibular alveolar bone of Sprague–Dawley rats fed either a normal/hard or a soft diet. Methods: Eighty six-month-old female Sprague–Dawley rats underwent transabdominal ovariectomy (OVX) or sham operation (SHAM), and were pair-fed isocaloric diets containing either 15% or 2.5% casein. For half of the animals the food was given in the usual form of pellets (hard consistency), while for the other half it had a soft, porridge-like, consistency. The experiment lasted 16 weeks. Micro-computed tomographic histomorphometry was used in order to evaluate the association between systemic bone loss and mandibular alveolar bone. Results: All experimental factors (ovariectomy, protein undernutrition, and soft diet) had a significantly negative impact on the micro-architecture of the mandibular alveolar bone. Soft diet led to a reduction of mandibular BV/TV (p = 0.001), trabecular thickness (p = 0.012), trabecular number (p < 0.001), and an increase of trabecular spacing (p < 0.001). Ovariectomy led to 8.2% reduction of mandibular BV/TV for those animals fed the normal diet, but to 21.2% reduction of BV/TV for those fed the soft diet. Protein undernutrition led to 15.4% and 16.1% reduction of BV/TV, respectively. Conclusion: The negative effect of estrogen deficiency on mandibular alveolar bone was attenuated due to mechanical loading during normal masticatory function. On the contrary, bone loss due to protein undernutrition was not significantly influenced by the alteration of masticatory function. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.291

P380 Use of protonpump inhibitors and risk of hip fracture A. Lalmohameda,*, S. Pouwelsa, C. Cooperb, T. van Staab, B. Leufkensa, A. de Boera, F. de Vriesa a Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands b MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton, UK Background: Evidence from observational studies suggests that use of protonpump inhibitors (PPIs) is associated with low bone mineral density and increased risk of hip fracture. Given the current evidence, a causal relationship would be supported by higher fracture risks after prolonged PPI use, especially after exposure periods exceeding 1 year. Objective: To examine the association between the use of PPIs and the risk of hip fracture, with particular reference to long-term use. Design and subjects: Using the population-based Dutch PHARMO (www.pharmo.nl) database, a case-control study was conducted. The study cohort included data from 6763 cases aged 18 years and older with a first hip/femur fracture during enrolment (1991–2002). To each case, up to four controls were matched by age, gender and region. We adjusted our analysis for disease and drug history. Results: Current users of PPIs had an increased risk of hip fracture (adjusted [adj.] OR 1.20; 95% CI 1.04–1.40), which is in line with data from the UK and Denmark. However, hip fracture risk attenuated