In patients with type 2 diabetes mellitus (T2DM), advanced glycation end products (AGEs) play a role in bone fragility, according to a new study presented at the recently concluded 5th Scientific Meeting of the Asian Federation of Osteoporosis Societies (AFOS 2017).

In particular, urinary concentrations of pentosidine predict susceptibility to fractures and, when used with trabecular bone scores in the clinical setting, may be effective noninvasive markers in assessing bone quality.

High-performance liquid chromatography was used to determine the urinary levels of pentosidine in 192 participants, of whom 118 had T2DM while 72 did not. Pentosidine levels, bone mineral density (BMD) and trabecular bone scores (TBS) were compared between patients with and without vertebral fractures (VF) in the T2DM and non-T2DM groups.

In the T2DM group, patients positive for VF had significantly higher BMD of the lumbar spine (1.10 vs 0.95; p=0.003) and TBS (1.41 vs 1.35; p=0.029). In contrast, levels of urinary pentosidine were significantly higher in patients with VF (1.20 vs 1.45; p=0.032) than in those without. [AFOS 2017, abstract BPA05]

In the non-T2DM group, only the BMD of the lumbar spine showed a significant difference, with individuals positive for VF earning higher scores (0.91 vs 0.77; p=0.006). The two groups were comparable in terms of TBS (p=0.136) and urinary pentosidine levels (p=0.574).

In multivariate stepwise regression analysis adjusted for pentosidine, age, sex, body mass index, HbA1c levels, serum creatinine, lumbar spine BMD and 25-hydroxyvitamin D levels, pentosidine was found to be a significant predictor of TBS (β, -0.046; p=0.024) in T2DM patients.

Age (β, -0.006; p<0.001) and 25-hydroxyvitamin D levels (β, -0.003; p=0.049) also emerged as significant predictors of TBS in T2DM patients.