Lower appendicular skeletal muscle mass linked to lower BMD, higher osteoporosis risk
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People with diabetes and less appendicular skeletal muscle mass are more likely to have lower bone mineral density in the lumbar spine, hip and femoral neck and are at a greater risk for osteoporosis, according to study data.
Youjin Pan, MD, and Jing Xu, MD, of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, China, wrote that appendicular skeletal muscle mass adjusted by height may be used as a predictor for osteoporosis in people with diabetes.
“To our knowledge, this is the first report showing a direct association between appendicular skeletal muscle mass adjusted by height and BMD and osteoporosis in type 2 diabetes,” the researchers wrote in a study published in the Journal of Diabetes Investigation. “Appendicular skeletal muscle mass adjusted by height might be a simple predictor of BMD in patients with type 2 diabetes.”
Pan and Xu analyzed data from 447 adults aged 50 years or older with type 2 diabetes treated at the Second Affiliated Hospital of Wenzhou Medical University and Yuying Children’s Hospital in China in 2017. Researchers obtained BMI, blood pressure, duration of diabetes, smoking and alcohol consumption history. Blood samples were collected to measure glucose and bone metabolism markers. BMD at the total lumbar spine, total hip and femur neck was measured for each participant. Lean body mass of the arms and legs was measured through dual bioelectrical impedance analyzer. The researchers then calculated appendicular skeletal muscle mass adjusted by height to correct for each participants’ body size. Men and women were analyzed separately.
The BMD of men was higher than woman in the lumbar spine (T-score, 1.073 vs. 0.925) femur neck (T-score, 0.827 vs. 0.738) and total hip (T-score, 0.896 vs. 0.809; P < .01 for all). Fasting blood glucose, total cholesterol, triglycerides, HDL cholesterol and incidences of osteoporosis were lower in men compared with women. Appendicular skeletal muscle mass and appendicular skeletal muscle mass adjusted by height were higher in men vs. women. Having a higher appendicular skeletal muscle mass adjusted by height was correlated with greater lumbar spine BMD, femoral neck BMD and total hip BMD in both men and women.
Appendicular skeletal muscle mass adjusted by height was independently associated with BMD in all three areas examined for both men and women with a BMI of less than 24 kg/m2. For those with a BMI greater than 24 kg/m2, appendicular skeletal muscle mass adjusted by height was independently associated with BMD in the total lumbar spine, hip and femoral neck for women, but not men. Appendicular skeletal muscle mass adjusted by height was associated with BMD in men younger than 65 years in the total hip and femoral neck, and in women younger than 65 years in the total lumbar spine, hip and femoral neck. For men older than 65 years, appendicular skeletal muscle mass adjusted by height was associated with BMD at the total hip, lumbar spine and femoral neck.
An increased risk for osteoporosis was observed for men with appendicular skeletal muscle mass adjusted by height less than 7.87 kg/m2 (OR = 6.036; 95% CI, 2.389-15.325; P = .001) or women with appendicular skeletal muscle mass adjusted by height less than 5.94 kg/m2 (OR = 4.079; 95% CI, 1.44-11.559; P = .008).
“The gender distinction in the relation of muscle and bone can be explained by gender-specific effects of gender hormones,” the researchers wrote. “In males, changes in bone and muscle are controlled by elevated testosterone and IGF-I level, which lead to increased muscle strength and mass, while in females, higher level of estrogen lead to bone mass tending to growth more rapidly in relation to muscle.”
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