Bone marrow adiposity in premenopausal women with type 2 diabetes with observations on peri-trabecular adipocytes.

Andrade, Vicente F C; Besen, Débora; Chula, Domingos C; Borba, Victória Z C; Dempster, David; Moreira, Carolina Aguiar

CONTEXT No study has evaluated the relationships among of bone marrow adiposity(BMA), bone histomorphometry(BH) and glycemic control in premenopausal women with type 2 diabetes(T2DM). OBJECTIVES Assess the effect of glycemic control on BMA;correlate the parameters of BH with BMA and correlate BMA with the use of hypoglycemic agents and with BMD. DESIGN, SETTINGS AND PATIENTS This was a cross-sectional study that evaluated 26 premenopausal women with T2DM were divided into groups with HbA1c<7% (GC,n=10) and HbA1c>7% (PC,n=16).BMA parameters (Ad.N, Ad.Pm, Ad.Ar, Ad.V/Ma.V and peri-trabecular adipocyte number (Ad.N/BS) were evaluated.BH static(BV/TV, O.Th, OS/BS) and dynamic parameters and serum IGF-1 were measured.BMA data were compared between the GC vs PC groups. Correlations were performed. RESULTS Ad.N, Ad.Pm and Ad.Ar were higher in PC(all, p=0.04). HbA1c correlated positively with Ad.N/BS(p< 0.01) and Ad.N/BS correlated negatively with O.Th(p<0.01) and OS/BS(p=0.02). Positive and negative correlations were observed between insulin and metformin use, respectively, with all adipocyte parameters except Ad.N/BS(p<0.05). Structural parameters were negatively correlated with the BMA. BMD of the femoral neck(r = -549, p<0.01) and total femur(r=-0.502, p<0.01) were negatively correlated with Ad.V/Ma.V. CONCLUSION Poor glycemic control is associated with hyperplasia and hypertrophy of BMAs and with lower BVTV. Ad,N/BS, a new BMA parameter, is correlated with HbA1c and negatively with O.Th. The use of insulin seems to stimulate the expansion of BMA while that of metformin has the opposite effect. These findings suggest that the increase in BMA may play a role in the T2DM bone disease, on the other hand, good glycemic control might help prevent it.