The relationship between insulin resistance, bone mineral density, and fracture risk in postmenopausal women

Danijela Bazić Sretenović; Mirjana Veselinović; Tamara Nikolić Turnić; Anja Azanjac; Aleksandra Korićanac; Aleksandra Tomić Lučić

doi:10.2298/VSP210216041B

Danijela Bazić Sretenović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Mirjana Veselinović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Tamara Nikolić Turnić University of Kragujevac, Faculty of Medical Sciences, Department of Clinical Pharmacy, Kragujevac, Serbia
Anja Azanjac University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Aleksandra Korićanac General Hospital Kraljevo, Department of Internal Medicine, Kraljevo, Serbia
Aleksandra Tomić Lučić University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP210216041B

Keywords: bone density, fractures, bone, insulin resistance, postmenopause, risk assessment, serbia

Abstract

Background/Aim. Skeletal muscles and bones are essential tissues that, in addition to supporting the body, are the primary site of postprandial glucose intake, which is significantly associated with insulin resistance. The aim of this study was to determine the effect of insulin resistance on bone mineral density (BMD) and fracture risk and re-evaluate the relationship between muscle properties and BMD and insulin resistance in postmenopausal women in Serbia. Methods. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated in postmenopausal women who were divided into two groups. The “cut-off” value of insulin resistance for the group with “Low HOMA-IR” was < 2, and for “High HOMA-IR” > 2. Fat mass (FM), lean mass (LM), and BMD were measured on the hip and spine using a densitometer with dual-energy X-ray absorptiometry. Results. FM and LM had an evident impact on BMD. The decrease in LM and fat buildup was associated with a higher incidence of insulin resistance. A positive correlation was confirmed between HOMA-IR and BMD on the spine and hip, but there was no correlation between insulin resistance and fracture risk. Conclusion. LM and FM have significant effects on BMD. The association between LM, FM, BMD and the onset of insulin resistance in postmenopausal women is confirmed. However, women with higher insulin resistance levels and higher BMD do not have a lower fracture risk.

References

DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care 2009; 32(Suppl 2): S157‒63.

Kalamari M, Leek F, Wang NX, Koh HR, Roy NC, Cameron-Smith D, et al. Association of Insulin Resistance with Bone Strength and Bone Turnover in Menopausal Chinese-Singaporean Women without Diabetes. Int J Environ Res Public Health 2018; 15(5): 889.

Sciorati C, Rigamonti E, Manfredi AA, Rovere-Querini P. Cell death, clearance and immunity in the skeletal muscle. Cell Death Differ 2016; 23(6): 927‒37.

Hamrick MW. The skeletal muscle secretome: an emerging player in muscle-bone crosstalk. Bonekey Rep 2012; 1: 60.

Shanbhogue VV, Finkelstein JS, Bouxsein ML, Yu EW. Associa-tion Between Insulin Resistance and Bone Structure in Nondi-abetic Postmenopausal Women. J Clin Endocrinol Metab 2016; 101(8): 3114‒22.

Nikolić S, Ćurić NJ, Mijović R, Ilinčić B, Ben D. Significance and role of homeostatic model assessment in the evaluation of glu-cose regulation mechanisms. Med Pregl 2017; 70(5‒6): 155‒61.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412‒9.

Ho-Pham LT, Nguyen ND, Lai TQ, Nguyen TV. Contributions of lean mass and fat mass to bone mineral density: a study in postmenopausal women. BMC Musculoskelet Disord 2010; 11: 59.

Jiang Y, Zhang Y, Jin M, Gu Z, Pei Y, Meng P. Aged-Related Changes in Body Composition and Association between Body Composition with Bone Mass Density by Body Mass Index in Chinese Han Men over 50-year-old. PLoS One 2015; 10(6): e0130400.

Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clini-cal and epidemiological studies: towards a standardized ap-proach. Age Ageing 2011; 40(4): 423–9.

Mathiowetz V. Comparison of Rolyan and Jamar dynamome-ters for measuring grip strength. Occup Ther Int 2002; 9(3): 201–9.

Beaudart C, Rolland Y, Cruz-Jentoft AJ, Bauer JM, Sieber C, Cooper C, et al. Assessment of Muscle Function and Physical Performance in Daily Clinical Practice: A position paper en-dorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Calcif Tissue Int 2019; 105(1): 1‒14.

Hars M, Biver E, Chevalley T, Herrmann F, Rizzoli R, Ferrari S, et al. Low Lean Mass Predicts Incident Fractures Inde-pendently From FRAX: a Prospective Cohort Study of Re-cent Retirees. J Bone Miner Res 2016; 31(11): 2048‒56.

Lippuner K, Johansson H, Kanis JA, Rizzoli R. FRAX assessment of osteoporotic fracture probability in Switzerland. Osteopo-rosis Int 2010; 21(3): 381–9.

Liu PY, Ilich JZ, Brummel-Smith K, Ghosh S. New insight into fat, muscle, and bone relationship in women: determining the threshold at which body fat assumes a negative relationship with bone mineral density. Int J Prev Med 2014; 5(11): 1452–63.

Ijuin M, Douchi T, Matsuo T, Yamamoto S, Uto H, Nagata Y. Dif-ference in the effects of body composition on bone mineral density between pre- and postmenopausal women. Maturitas 2002; 43(4): 239–44.

Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older per-sons. Epidemiol Rev 2013; 35: 51–65.

Kim SW, Lee HA, Cho EH. Low handgrip strength is associat-ed with low bone mineral density and fragility fractures in postmenopausal healthy Korean women. J Korean Med Sci 2012; 27(7): 744‒7.

Bayramoglu M, Sozay S, Karatas M, Kilinc S. Relationships be-tween muscle strength and bone mineral density of three body regions in sedentary postmenopausal women. Rheumatol Int 2005; 25(7): 513‒7.

Lundin H, Sääf M, Strender LE, Nyren S, Johansson SE, Salminen H. Gait speed and one-leg standing time each add to the pre-dictive ability of FRAX. Osteoporos Int 2017; 28(1): 179‒87.

Sakazaki T, Koike T, Yanagimoto Y, Oshida Y. Association be-tween gait speed and bone strength in community-dwelling postmenopausal Japanese women. Environ Health Prev Med 2012; 17(5): 394–400.

Park HS, Lim JS, Lim SK. Determinants of Bone Mass and In-sulin Resistance in Korean Postmenopausal Women: Muscle Area, Strength, or Composition? Yonsei Med J 2019; 60(8): 742‒50.

Srikanthan P, Crandall CJ, Miller-Martinez D, Seeman TE, Greendale GA, Binkley N, et al. Insulin resistance and bone strength: findings from the study of midlife in the United States. J Bone Miner Res 2014; 29(4): 796‒803.

Chapman NM, Chi H. Dietary fat inflames CD4+ T cell memory in obesity. Cell Metab 2017; 25(3): 490‒2.

Mauro C, Smith J, Cucchi D, Coe D, Fu H, Bonacina F, et al. Obesity-induced metabolic stress leads to biased effector memory CD4+ T cell differentiation via PI3K p110δ-Akt-mediated signals. Cell Metab 2017; 25(3): 593‒609.