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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/24851

Title: The association between insulin use and volumetric bone mineral density, bone micro-architecture and bone strength of the distal radius in patients with type 2 diabetes - The Maastricht study
Authors: de Waard, E. A. C.
Driessen, J. H. M.
de Jong, J. J. A.
van Geel, T. A. C. M.
Henry, R. M. A.
van Onzenoort, H. A. W.
Schram, M. T.
Dagnelie, P. C.
van der Kallen, C. J.
Sep, S. J. S.
Stehouwer, C. D. A.
Schaper, N. C.
Koster, Annette
Savelberg, H. H. C. M.
Neef, C.
Geusens, Piet P.M.M.
de Vries, F.
van den Bergh, Joop P. W.
Issue Date: 2017
Publisher: ELSEVIER SCIENCE INC
Citation: BONE, 101, p. 156-161
Abstract: Type 2 diabetes mellitus (T2DM) has been associated with an increased risk of fractures, despite normal to increased bone mineral density (BMD). Insulin use is one of the factors linked to this increased fracture risk. However, direct negative effects of insulin on bone quality are not expected since insulin is thought to be anabolic to bone. In this cross-sectional study the association between insulin use and volumetric BMD (vBMD), bone micro architecture and bone strength of the distal radius, as measured with HR-pQCT, was examined. Data from 50 participants with T2DM of The Maastricht Study (mean age 62 +/- 7.5 years, 44% women) was used. Participants were classified as insulin user (n = 13) or non-insulin user (n = 37) based on prescription data. Linear regression analysis was used to estimate the association between current insulin use and HR-pQCF derived parameters. After adjustment for age, sex, body mass index, glycated hemoglobin Al c and T2DM duration, insulin use was associated with lower total vBMD (standardized beta (beta):-0.56 (95% CI: 0.89 to 0.24)), trabecular vBMD ((3:-0.58 (95% CI: 0.87 to 0.30)), trabecular thickness (beta: 0.55 (95% CI: 0.87 to 0.23)), cortical thickness (beta: 0.41 (95% CI: 0.74 to 0.08)), log cortical pore volume (beta: 0.43 (95% Cf: 0.73 to 0.13)), bone stiffness (beta:-0.39 (95% CI: 0.62 to 0.17)) and failure load (beta:-0.39 (95% CI: 0.60 to 0.17)) when compared to the non-insulin users. Insulin use was not associated with cortical vBMD, trabecular number, trabecular separation, cortical porosity and cortical pore diameter. This study indicates thatinsulin use is negatively associated with bone density, bone micro-architectural and bone strength parameters: These findings may partly explain the previously observed increased fracture risk in insulin users, although there may be residual confounding by other factors related to disease severity in insulin users. (C) 2017 Elsevier Inc. All rights reserved.
Notes: [de Waard, E. A. C.; de Jong, J. J. A.] Maastricht Univ, Dept Internal Med, Maastricht, Netherlands. [de Waard, E. A. C.; Driessen, J. H. M.; de Jong, J. J. A.; Savelberg, H. H. C. M.; van den Bergh, J. P. W.] Maastricht Univ, NUTRIM Sch Nutr & Translat Res Metab, Maastricht, Netherlands. [Driessen, J. H. M.; de Vries, F.] Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands. [Driessen, J. H. M.; van Geel, T. A. C. M.; Dagnelie, P. C.; Koster, A.; Neef, C.; Geusens, P. P. M. M.; de Vries, F.] Maastricht Univ, CAPHRI Sch Publ Hlth & Primary Care, Maastricht, Netherlands. [Driessen, J. H. M.; van Onzenoort, H. A. W.; Neef, C.; de Vries, F.] Maastricht Univ, Med Ctr, Dept Clin Pharm & Toxicol, Maastricht, Netherlands. [van Geel, T. A. C. M.] Maastricht Univ, Dept Family Med, Maastricht, Netherlands. [Henry, R. M. A.; Schram, M. T.; van der Kallen, C. J.; Sep, S. J. S.; Stehouwer, C. D. A.; Schaper, N. C.; Geusens, P. P. M. M.; van den Bergh, J. P. W.] Maastricht Univ, Med Ctr, Dept Internal Med, Maastricht, Netherlands. [Henry, R. M. A.; Schram, M. T.; Dagnelie, P. C.; van der Kallen, C. J.; Sep, S. J. S.; Stehouwer, C. D. A.; Schaper, N. C.] Maastricht Univ, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands. [Schram, M. T.] Maastricht Univ, Med Ctr, Heart & Vasc Ctr, Maastricht, Netherlands. [van Onzenoort, H. A. W.] Radboud Univ Nijmegen, Med Ctr, Dept Pharm, Nijmegen, Netherlands. [Dagnelie, P. C.] Maastricht Univ, Dept Epidemiol, Maastricht, Netherlands. [Koster, A.] Maastricht Univ, Dept Social Med, Maastricht, Netherlands. [Savelberg, H. H. C. M.] Maastricht Univ, Dept Human Movement Sci, Maastricht, Netherlands. [Geusens, P. P. M. M.] Univ Hasselt, Biomed Res Inst, Hasselt, Belgium. [de Vries, F.] Southampton Gen Hosp, MRC Epidemiol Lifecourse Unit, Southampton, Hants, England. [van den Bergh, J. P. W.] VieCuri Med Ctr, Dept Internal Med, Subdiv Endocrinol, Venlo, Netherlands.
URI: http://hdl.handle.net/1942/24851
DOI: 10.1016/j.bone.2017.05.004
ISI #: 000404319300019
ISSN: 8756-3282
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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