Prevalence and Associated Factors of Metabolic Bone Disease in Men with Type 2 Diabetes Mellitus

Abstract INTRODUCTION Postmenopausal women and people over the age of 70 are more likely to develop osteoporosis. It is recognized as significant comorbidity among those with type 2 diabetes mellitus (T2DM), and male fractures are on the rise with higher rates of mortality than women (37.5% vs 28.2% respectively). However, there is a scarcity of data linking T2DM and metabolic bone disease in men. OBJECTIVE Our study aimed to determine the prevalence of metabolic bone diseases, including osteoporosis and osteopenia, and the associated factors, bone turnover markers, and vitamin D in men with T2DM. METHOD This is a cross-sectional, single-center study in men above 50 years of age with T2DM, conducted from December 2021 to June 2022. Demographic data, baseline comorbidities, and biochemical profiles including urine albumin-creatinine ratio (UACR) was obtained. Bone turnover markers including C-terminal telopeptide of type I collagen (CTX) and bone-specific alkaline phosphates (bsALP) were measured. Osteoporosis and osteopenia were determined by Dual Energy X-ray Absorptiometry (DEXA). RESULT Total of 148 men with T2DM with a median age of 64 (IqR 11) years was recruited. The prevalence of metabolic bone disease in the study population was 20.3%. Multivariate analysis shows total bilirubin level [OR: 1.13 (95% CI: 1.050, 1.223) p<0.001], high intact parathyroid hormone (iPTH) level ≥6.9 pmol/L [OR 3.05 (95% CI: 1.141, 8.187), p=0.026] and use of dipeptidyl peptidase-4 inhibitor (DPP4i) [OR 0.274 (95% CI: 0.093, 0.809) p=0.01] are predictors of metabolic bone disease in the study population. CONCLUSION Metabolic bone disease affects about 1 in 5 men with T2DM patients, and its risk factors include increased total bilirubin and iPTH level. The use of DPP4i for the treatment of T2DM was shown to be somewhat protective against metabolic bone disease. There is a need to identify metabolic bone disease in men with T2DM so early intervention could be initiated to prevent fractures.