The Effects of Diabetic Polyneuropathy and Autonomic Neuropathy on Bone Turnover

Background: The effect of diabetic polyneuropathy (DPN) and autonomic neuropathy (AN) on bone turnover in type 2 diabetes mellitus (DM) is uncertain due to the lack of data. In this study, we tried to determine the effect of DPN and AN on bone metabolism. Materials and Methods: The study included patients with type 2 DM (aged 18-80 years) and age-matched healthy individuals who presented to the Departments of Metabolism and Diabetes, Geriatrics, and General Internal Medicine, Cerrahpaa Medical School, Istanbul University. The patients were examined to find out whether they had AN, and neuropathy scores were recorded by exploring peripheral neuropathy. Bone mineral density was measured by dual-energy X-ray (DXA). Demographic characteristics, the presence of microvascular complications, and biochemical data were obtained from patients' files. Serum cross-linked C-telopeptide (Ctx), osteocalcin, and bone-specific alkaline phosphatase (B-ALP) were analyzed. Results: The study comprised a total of 64 patients: 23 had type 2 DM and osteoporosis (OP) (duration of diabetes 10.17 years; mean age 63 +/- 9.1 years; female/male 18/5; Group 1), 41 had type 2 DM and non-OP (duration of diabetes 10.3 +/- 7.6 years; mean age 58 +/- 7.4 years; female/male 30/11; Group 2), and 26 healthy volunteers made up the control group (mean age 62 +/- 11.9 years; female/male 14/12; Group 3). The bone turnover parameters were lower in type 2 DM individuals. The levels of osteocalcin (13.3 +/- 5.2ng/mL) and B-ALP (44.7 +/- 10.9 IU/L) in patients with type 2 DM were lower than those of healthy subjects: osteocalcin (20.6 +/- 10ng/mL) and B-ALP (111 +/- 31.4 IU/L; P=0.001 and P=0.000, respectively). Ctx levels (193.5 +/- 49.3; 207.6 +/- 40ng/mL) were recorded to be similar (P=0.2). AN was also noted as a risk factor for OP. For patients without AN, the likelihood of developing OP (odds ratio) was 0.7. The corresponding ratio for patients with AN was 9.3. Conclusions: Among the independent variables, the neuropathy score was determined to have an impact on bone turnover. AN was identified to be a significant risk factor for OP.