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1 November 1995 | Volume 123 Issue 9 | Page 731
Dr. van Daele and colleagues [1] have provided further evidence to support an association between non-insulin-dependent diabetes mellitus and increased bone mineral density. They speculate that this is an anabolic effect of insulin but did not acknowledge the information on bone biochemistry and bone histomorphometry that suggests a reduction in bone formation rather than an anabolic effect [2-5]. A reduction in bone turn-over could account both for patients' failure to accumulate bone during bone growth (yielding a low bone density in patients with insulin-dependent diabetes mellitus) and also for diminution of age-related bone loss in patients with non-insulin-dependent diabetes mellitus—a unifying hypothesis for the effect of diabetes mellitus on bone [3-5].
A state of low bone turnover facilitates the accumulation of microdamage in bone and thus increases the risk for stress fractures. We have speculated about whether this microdamage might predispose patients with diabetes mellitus to foot fractures [3-5]. Dr. van Daele and associates found a lower prevalence of nonvertebral fractures in women than in controls. This lower prevalence was not seen with men. The authors mention that the ankle and foot were the most common sites of fracture in men and the second most common sites in women. Did these patients have stress fractures? Did stress fractures in the foot occur more frequently than in controls?
1. van Daele PL, Stolk RP, Burger H, Algra D, Grobbee DE, Hofman A, et al. Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam Study. Ann Intern Med. 1995; 122:409-14.
2. Wu K, Schubeck E, Frost HM, Villaneuva A. Haversian bone formation rates determined by a new method in a mastodon, and in diabetes mellitus, and in osteoporosis. Calcif Tissue Res. 1970; 6:204-9.
3. McKenna MJ. Miscellaneous causes of osteoporosis. In: Favus MJ, ed. Primer on Metabolic Bone Diseases and Disorders of Mineral Metabolism. New York: Raven Pr; 1993:258-62.
4. Krakauer JC, McKenna MJ, Rao DS, Fenn NS, Parfitt AM, Whitehouse FW. Long term preservation of bone mass in diabetes mellitus. Calcif Tissue Int. 1993; 52(Suppl 2):S27.
5. Krakauer J, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM. Bone loss and bone turnover in diabetes mellitus. Diabetes 1995; 44:775-82. About Letters
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LETTER
Bone Mineral Density in Non-Insulin-Dependent Diabetes Mellitus
TO THE EDITOR:
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St. Michael's Hospital; Dublin Ireland.
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