J Bone Metab.  2016 Feb;23(1):1-7. 10.11005/jbm.2016.23.1.1.

The Association between Urine Albumin to Creatinine Ratio and Osteoporosis in Postmenopausal Women with Type 2 Diabetes

• Lee YY
• Kim HB
• Lee JW
• Lee GM
• Kim SY
• Hur JA
• Cho HC

• KMID: 2156280
• DOI: http://doi.org/10.11005/jbm.2016.23.1.1

Abstract

BACKGROUND
Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass density and destruction of microstructure, which can lead to an increased risk of fracture. Although many studies have been published about the relationship between end-stage renal disease and osteoporosis, research on the relationship between proteinuria and the prevalence of osteoporosis is still lacking.
METHODS
We assessed 91 postmenopausal women with type 2 diabetes who visited our hospital from January 2009 to January 2012.
RESULTS
Among 91 patients, the prevalence of osteoporosis and osteopenia was 35.2% (32 cases) and 32.9% (30 cases) according to bone mineral density. The patients with microalbuminuria and macroalbuminuria (urine albumin-to-creatinine ratio [UACR] > or = 30) had a significantly higher incidence of osteoporosis compared to subjects with normoalbuminuria (P<0.05).
CONCLUSIONS
This study indicates that UACR may be a useful biomarker for increased risk of osteoporosis in postmenopausal women with type 2 diabetes who have been linked to higher UACR levels.

Keyword

Albumins; Creatinine; Diabetes mellitus type 2; Osteoporosis postmenopausal

MeSH Terms

Albumins
Bone Density
Bone Diseases
Bone Diseases, Metabolic
Creatinine*
Female
Humans
Incidence
Kidney Failure, Chronic
Osteoporosis*
Prevalence
Proteinuria
Albumins
Creatinine

Reference

1. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994; 4:368–381.

2. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993; 8:1137–1148.

3. Weitzmann MN, Pacifici R. Estrogen deficiency and bone loss: an inflammatory tale. J Clin Invest. 2006; 116:1186–1194.

4. Leidig-Bruckner G, Ziegler R. Diabetes mellitus a risk for osteoporosis? Exp Clin Endocrinol Diabetes. 2001; 109:Suppl 2. S493–S514.

5. Räkel A, Sheehy O, Rahme E, et al. Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab. 2008; 34:193–205.

6. Qorbani M, Bazrafshan HR, Aghaei M, et al. Diabetes mellitus, thyroid dysfunctions and osteoporosis: is there an association? J Diabetes Metab Disord. 2013; 12:38.

7. Korea National Health and Nutrition Examination Survey. Korea health statistics 2012: Korea national health and nutrition examination survey. 2013. cited by 2013 Dec 27. Available from: http://stat.mohw.go.kr/front/statData/publicationView.jsp?menuId=47&bbsSeq=13&nttSeq=21193&searchKey=&searchWord=&nPage=1.

8. Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994; 9:1137–1141.

9. Rishaug U, Birkeland KI, Falch JA, et al. Bone mass in non-insulin-dependent diabetes mellitus. Scand J Clin Lab Invest. 1995; 55:257–262.

10. van Daele PL, Stolk RP, Burger H, et al. Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam study. Ann Intern Med. 1995; 122:409–414.

11. Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes-a meta-analysis. Osteoporos Int. 2007; 18:427–444.

12. Hruska KA, Teitelbaum SL. Renal osteodystrophy. N Engl J Med. 1995; 333:166–174.

13. Williams ME. Chronic kidney disease/bone and mineral metabolism: the imperfect storm. Semin Nephrol. 2009; 29:97–104.

14. Kazama JJ, Matsuo K, Iwasaki Y, et al. Chronic kidney disease and bone metabolism. J Bone Miner Metab. 2015; 33:245–252.

15. Shan PF, Wu XP, Zhang H, et al. Bone mineral density and its relationship with body mass index in postmenopausal women with type 2 diabetes mellitus in mainland China. J Bone Miner Metab. 2009; 27:190–197.

16. Park YM, Ko SH, Lee JM, et al. Glycaemic and haemoglobin A1c thresholds for detecting diabetic retinopathy: the fifth Korea National Health and Nutrition Examination Survey (2011). Diabetes Res Clin Pract. 2014; 104:435–442.

17. Levey AS, Inker LA, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis. 2014; 63:820–834.

18. Drion I, Joosten H, Santing L, et al. The Cockcroft-Gault: a better predictor of renal function in an overweight and obese diabetic population. Obes Facts. 2011; 4:393–399.

19. Ellam T, Fotheringham J, Wilkie ME, et al. Bone mineral metabolism parameters and urinary albumin excretion in a representative US population sample. PLoS One. 2014; 9:e88388.

20. Molitch ME, DeFronzo RA, Franz MJ, et al. Nephropathy in diabetes. Diabetes Care. 2004; 27:Suppl 1. S79–S83.

21. Montagnani A, Gonnelli S, Alessandri M, et al. Osteoporosis and risk of fracture in patients with diabetes: an update. Aging Clin Exp Res. 2011; 23:84–90.

22. Kim HL, Park IY, Choi JM, et al. A decline in renal function is associated with loss of bone mass in Korean postmenopausal women with mild renal dysfunction. J Korean Med Sci. 2011; 26:392–398.

23. Nickolas TL, Leonard MB, Shane E. Chronic kidney disease and bone fracture: a growing concern. Kidney Int. 2008; 74:721–731.

24. Alem AM, Sherrard DJ, Gillen DL, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000; 58:396–399.

25. Elder G. Pathophysiology and recent advances in the management of renal osteodystrophy. J Bone Miner Res. 2002; 17:2094–2105.

26. Hutchison AJ, Whitehouse RW, Boulton HF, et al. Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease. Kidney Int. 1993; 44:1071–1077.

27. Jin DC. Current status of dialysis therapy in Korea. Korean J Intern Med. 2011; 26:123–131.

28. Smith HW. The kidney: structure and function in health and disease. London: Oxford University Press;1951.

29. Roett MA, Liegl S, Jabbarpour Y. Diabetic nephropathy--the family physician's role. Am Fam Physician. 2012; 85:883–889.

30. Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Soc Nephrol. 2006; 17:2106–2111.

31. Deen WM. What determines glomerular capillary permeability? J Clin Invest. 2004; 114:1412–1414.

32. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004; 109:Iii27–Iii32.

33. Jørgensen L, Jenssen T, Johnsen SH, et al. Albuminuria as risk factor for initiation and progression of carotid atherosclerosis in non-diabetic persons: the Tromso study. Eur Heart J. 2007; 28:363–369.

34. Uyama O, Yoshimoto Y, Yamamoto Y, et al. Bone changes and carotid atherosclerosis in postmenopausal women. Stroke. 1997; 28:1730–1732.

35. Seo SK, Cho S, Kim HY, et al. Bone mineral density, arterial stiffness, and coronary atherosclerosis in healthy postmenopausal women. Menopause. 2009; 16:937–943.

36. Baykara M, Öztürk C, Elbüken F. The relationship between bone mineral density and arterial stiffness in women. Diagn Interv Radiol. 2012; 18:441–445.

37. Bagger YZ, Tankó LB, Alexandersen P, et al. Radiographic measure of aorta calcification is a site-specific predictor of bone loss and fracture risk at the hip. J Intern Med. 2006; 259:598–605.

38. Danilevicius CF, Lopes JB, Pereira RM. Bone metabolism and vascular calcification. Braz J Med Biol Res. 2007; 40:435–442.

39. McFarlane SI, Muniyappa R, Shin JJ, et al. Osteoporosis and cardiovascular disease: brittle bones and boned arteries, is there a link? Endocrine. 2004; 23:1–10.

40. Miyaura C, Kusano K, Masuzawa T, et al. Endogenous bone-resorbing factors in estrogen deficiency: cooperative effects of IL-1 and IL-6. J Bone Miner Res. 1995; 10:1365–1373.