More Rapid Bone Mineral Density Loss in Older Men With Diabetes: The Osteoporotic Fractures in Men (MrOS) Study
Flavia Tramontana, Nicola Napoli, Stephanie Litwack‐Harrison, Douglas C. Bauer, Eric Orwoll, Jane A. Cauley, Elsa S. Strotmeyer, Ann V. Schwartz
Abstract
CONTEXT: Type 2 diabetes mellitus is associated with more rapid bone loss in women, but less evidence is available for men or those with prediabetes. OBJECTIVE: To determine whether bone loss rate is affected by diabetes status in older men, we analyzed data from the Osteoporotic Fractures in Men (MrOS) study. METHODS: The multisite MrOS study enrolled 5994 men aged ≥ 65 years. Diabetes status was defined by self-report, diabetes medication use, or elevated fasting serum glucose at baseline. Hip bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA) at baseline and a follow-up visit after 4.6 ± 0.4 years. This analysis included 4095 men, excluding those without follow-up DXA or with unknown diabetes status. Changes in hip BMD in participants with normoglycemia (NG), prediabetes, or type 2 diabetes, excluding thiazolidinedione (TZD) users, were evaluated using generalized linear models (GLM). Diabetes medication use and BMD loss among those with type 2 diabetes were also evaluated with GLM. RESULTS: In adjusted models, hip BMD loss was greater in men with type 2 diabetes (- 2.23%; 95% CI: -2.54 to -1.91; P < .001) but not in men with prediabetes (-1.45%; 95% CI -1.63 to -1.26; P = .33) compared with NG (-1.57%; 95% CI -1.73 to -1.41). Among men with type 2 diabetes, TZD, insulin, and sulfonylurea use were associated with greater hip BMD loss. CONCLUSION: Men with type 2 diabetes, but not prediabetes, experienced accelerated bone loss compared to participants with normoglycemia. More rapid bone loss predicts increased risk of fractures and mortality in broader populations.