Harald Dobnig, MD, department of internal medicine, division of endocrinology and nuclear medicine, Center for Medical Research, Medical University of Graz, Graz, Austria, led a research team in a prospective study of 583 ambulatory elderly patients (70 years of age and older) with type 2 diabetes mellitus living in 95 nursing homes across 4 countries.

Subjects were evaluated prospectively for non-vertebral fractures at their nursing homes by the same physician over 2 years.

The study also included a control group of 1081 subjects; 88% of the entire cohort had 25-hydroxy (25-OH) vitamin D levels below 15 ng/mL, vitamin D deficiency was widespread.

Patients with type 2 diabetes mellitus had significantly higher age-, weight- and mobility-score-adjusted calcaneal stiffness (P < .0001), radial speed of sound (P < .005) and phalangeal speed of sound (P < .05) measurements compared to controls.

Bone turnover proved to be an important significant independent determinant of bone ultrasound measurements, which were performed at the calcaneus, radius and proximal third phalanx.

Weight and quadriceps strength at the calcaneus as well as age at the radius and phalanx also were significant determinants.

Patients with type 2 diabetes mellitus and medical treatment with oral antidiabetics or insulin had serum parathyroid hormone and osteocalcin levels that were 20.7% and 22.3%, respectively, below those of control subjects (both P < .0001).

In a stepwise regression analysis, the most important determinants of bone turnover were parathyroid hormone in both controls and subjects and hemoglobin A1c in diabetes mellitus patients, explaining 30% to 40% of its variance.

A total of 110 hip fractures (6.3% of controls and 7.0% of diabetes patients) occurred over the observation period corresponding to a comparable hip fracture rate of 3.1% in controls and 3.4% in the diabetes patients per 100 patient-years.

Dr. Dobnig noted that, type 2 diabetes in a largely vitamin D-deficient female nursing home population is associated with significantly lower bone turnover and higher multivariate adjusted results on bone ultrasound measurements, according to the researchers. It is therefore of interest to learn whether the effect is consistent in older nursing-home residents.

Although diabetes mellitus was indeed found to have a protective effect on bone, it was offset by increased incidence of falls in elderly diabetics, Dr. Dobnig concluded.


[Presentation title: Type 2 Diabetes Mellitus in Nursing Home Patients: Effects on Bone Turnover, Bone Mass and Fracture Risk. Abstract 514]

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