Hypogonadal men with type 2 diabetes mellitus have smaller bone size and lower bone turnover

Introduction: Both hypogonadism and type 2 diabetes mellitus (T2D) are associated with increased fracture risk. Emerging data support the negative effect of low testosterone on glucose metabolism, however, there is little information on the bone health of hypogonadal men with diabetes. We evaluated the bone mineral density (BMD), bone geometry and bone turnover of hypogonadal men with T2D compared to hypogonadal men without diabetes. Materials and Methods: Cross-sectional study, men 40-74 years old, with average morning testosterone (done twice) of < 300 ng/dl. Areal BMD (aBMD) was measured by DXA; volumetric BMD (vBMD) and bone geometry by peripheral-quantitative-computed-tomography; serum C-telopeptide (CTX), osteocalcin, sclerostin and sex hormone-binding globulin (SHBG) by ELISA, testosterone and 25-hydroxyvitamin D (250HD) by automated immunoassay and estradiol by liquid-chromatography/mass-spectrometry. Groups were compared by ANOVA adjusted for covariates. Results: One-hundred five men, 49 with and 56 without diabetes were enrolled. Adjusted vBMD at 38% tibia was higher in diabetic than non-diabetic men (8573 +/- 69.0 mg/cm(3) vs. 828.7 +/- 96.7 mg/cm(3), p = 0.02). Endosteal (43.9 +/- 5.8 mm vs. 47.1 +/- 7.8 mm, p = 0.04) and periosteal (78.4 +/- 5.0 mm vs. 81.3 +/- 6.5 -mm, p = 0.02) circumferences and total area (491.0 +/- 61.0 mm(2) vs. 527.7 +/- 87.2 mm(2), p = 0.02) at 38% tibia, were lower in diabetic men even after adjustments for covariates. CTX (0.25 +/- 0.14 ng/ml vs. 0.40 +/- 0.19 ng/ml, p < 0.001) and osteocalcin (4.8 +/- 2.8 ng/ml vs. 6.8 +/- 3.5 ng/ml, p = 0.006) were lower in diabetic men; there were no differences in sclerostin and 250HD. Circulating gonadal hormones were comparable between the groups. Conclusion: Among hypogonadal men, those with T2D have higher BMD, poorer bone geometry and relatively suppressed bone turnover. Studies with larger sample size are needed to verify our findings and possible even greater risk for fractures among hypogonadal diabetic men. Published by Elsevier Inc.