The Paradoxical Impact of Diabetes Mellitus on Osteoporosis and Sarcopenia: The ParaDOS Study

Abstract Purpose Type 2 diabetes mellitus (T2DM), osteoporosis (OP) and sarcopenia are major public health problems related with higher fall/fracture risks, morbidity and mortality. Due to the lack of a comprehensive analysis among T2DM, OP and sarcopenia; we aimed to explore the impact of T2DM on OP and sarcopenia in postmenopausal women. Methods This cross-sectional study included postmenopausal women who admitted to the departments of physical & rehabilitation medicine, and endocrinology and metabolism. Demographic data, nutrition/cognition status and frailty scores were recorded. Sarcopenia-related parameters including SARC-F, anterior thigh muscle thickness, handgrip strength, chair stand test, gait speed, and one-leg stand test for balance were measured. ISarcoPRM algorithm was used for the diagnosis of sarcopenia. Results A total of 444 postmenopausal women were consecutively enrolled. T2DM patients (N = 158, 35.6%) had higher frequency of sarcopenia, but lower frequency of OP than controls (both p < 0.05). As regards regression analyses; T2DM - either under the treatment of oral antidiabetic drugs or insulin - had a negative association with presence of OP (about 2 to 3 times lower, respectively). The duration of T2DM had a positive association with sarcopenia and a negative association with balance (all p < 0.05). Conclusion T2DM has paradoxical effects on bone, muscle and balance. Although insulin treatment might have anabolic effects on bone (protecting OP), the disease (duration) itself has negative effects on sarcopenia/balance.