Association Between Serum Osteoprotegerin/Receptor Activator Of Nuclear Factor KappaB Ligand,25-(OH)VitD3Levels And Osteoporosis With Type2Diabetes Mellitus

Objective To investigate the relationships between serum osteoprotegerin(OPG)/receptor activator of nuclear factor kappaB ligand (RANKL),25-(OH)VitD3levels and osteoporosis with type2diabetes mellitus. Correlations between serum OPG/RANKL,25-(OH)VitD3levels and age, sex, duration of diabetes, plasma glucose levels, sex hormone levels and bone mineral density will be analyzed.Methods According to their bone mineral density (BMD)level,250patients with type2diabetes were divided into two groups:normal BMD group and low BMD group. Plasma glucose, HbAlc,insulin, c-peptide, sex hormones, PTH, Ca, P,ALP were measured. BMD at the posteranterior lumbar spine-lumbar spine4,lumbar spinel-4, femoral neck, tuberosity and the whole body were examined by dual-energy x-ray absorptiometry (DEXA). Serum OPG, RANKL and25-(OH)VitD3were measured by enzyme-linked immuno sorbent assay(ELISA).Results1. Diabetes with normal BMD had significant higher OPG/RANKL ratio (0.73±0.14vs0.70±0.15, P<0.05) and significantly lower RANKL level (402.52±40.90vs418.87±47.82pg/ml, P<0.05) than low BMD group.2. In the low BMD group, OPG was positively associated with BMD of L1-L4, L1-4. OPG/RANKL ratio was positively associated with BMD of L1-L4, L1-4, left forearm and right forearm. RANKL was negatively associated with BMD of L1-L4, L1-4, left forearm and right forearm. This correlation persisted after adjustment for age, duration of diabetes, E2, and duration after menopause.3.25-(OH)VitD3level was lower in diabetic patients than normal reference range(27.7±11.0pg/ml),but there was no significant difference of25-(OH)VitD3level between normal and low BMD diabetic patients(21.63±2.89vs21.21±2.82pg/ml, P>0.05). 4. Age, duration of diabetes, weight, PTH, FSH, LH, E2, Testo were significant different between two groups. Multiple regression analysis found that RANKL, age, Testo were independent factors related with low BMD in diabetic patients.Conclusions1.OPG/RANKL ratio was lower whereas RANKL was higher in diabetic patients with low BMD. OPG/RANKL ratio was positively associated with BMD at Ll,L2,L3,L4,Ll-4, left and right forearm, suggesting that OPG/RANKL system play an important role in diabetic osteoporosis.2.25-(OH) VitD3level was lower in diabetic patients which suggests VitD deficiency might contribute to the development of diabetes.3.Age,duration of diabetes, weight,PTH,FSH,LH E2,Testo were related with diabetic osteoporosis.