Study of Bone Mineral Density and Bone Alkaline Phosphatase in Type 2 Diabetic Mellitus Postmenopausal Women in Kerbala.

Abstract

Background: The most prevalent metabolic bone disease among postmenopausal women with type 2 diabetes is osteoporosis. Even in those with normal or elevated bone mineral density (BMD), type 2 diabetes is associated with a higher fracture incidence than the non-diabetic population. As a result, the pathophysiology of bone fragility brought on by type 2 diabetes (T2DM) is significantly influenced by bone quality. A decline in BMD that is below normal reference levels but not low enough to satisfy the diagnostic standards for osteoporosis is referred to as osteopenia. BMD is diagnosed via dual-energy X-ray absorptiometry bone scans. An ectoenzyme called bone alkaline phosphatase (BALP) is affixed to the outside of osteoblast cell membranes. It enters the bloodstream in part. About 95% of the total ALP (TALP) activity in human serum is made up of liver ALP and BALP.

Aims: The aim is to determine whether diabetic postmenopausal osteoporosis (diabetic PMOP) and non-diabetic postmenopausal osteopenia have any influence on an increased risk of fracture in diabetic patients, the current study compares the studied results of BALP, Total ALP, BMD, body mass index (BMI), and age.

Materials and Methods: We performed a cross-sectional study in Kerbala medical hospital enrolling 80 subjects, 40 PMOP with T2DM, aged between (51-75) years, and 40 postmenopausal osteopenia without T2DM, aged between (50-74) years. All Patients had been in spontaneous menopause for at least, one year. For each subject we measured BMI, BMD, serum BALP, total ALP and T-scor during November, 2023 to September, 2024. Diabetic patients were collected from Al-Hassan center for Endocrinology and diabetes mellitus and Osteoporosis center at Al- Hassan Medical City, Kerbala Health Directorates, Kerbala/ Iraq. The mean and standard deviation of the parameters of the two groups were computed and compared by unpaired Student^'s T-test. The relationship between variables was measured by Karl Pearson^'s correlation coefficient. A statistical significance is set at a 5% level of significance (P < 0.05).

Result: Age and TALP were significantly higher in diabetic PMOP compared with non-diabetic osteopenia (62.8 ± 6.8 vs. 56.4 ± 7.37 year), (227.43± 61.46 vs. 201.50 ± 41.47 U/L), P<0.05. BMI was non-significant in diabetic PMOP compared with non-diabetic osteopenia (29± 4.72 vs.30.34 ± 4.64 kg/m²) P>0.05. BMD was significantly lower in diabetic PMOP compared with non-diabetic osteopenia (0.72 ± 0.06 vs. 0.86 ± 0.04 g/cm²) P<0.05. BALP was non-significantly higher in diabetic PMOP compared with non-diabetic osteopenia (52.33 ± 11.62 vs. 49.51 ± 7.64 ng/L) P>0.05. BMD of diabetic PMOP and non-diabetic osteopenia showed a non-significant negative correlation with BALP and TALP. T-scor was significantly lower in diabetic PMOP compared with non-diabetic osteopenia (-3.04 ± 0.45 vs. -1.64 ± 0.38) P <0.05.

Conclusions: Type 2 diabetic PMOP have BMD lower than the non-diabetic osteopenia. Low BMI in diabetic PMOP is an indicator for osteoporosis and its related fracture. In diabetic PMOP, T-scor is only predict by high level of BALP and TALP. Low levels of BALP and TALP are the predictors of T-scor in non-diabetic osteopenia.