Diabetes Is Associated Independently of Body Composition With BMD and Bone Volume in Older White and Black Men and Women: The Health, Aging, and Body Composition Study

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Abstract
The association between type 2 diabetes, BMD, and bone volume was examined to determine the effect of lean and fat mass and fasting insulin in the Health, Aging, and Body Composition Study, which included white and black well‐functioning men and women 70‐79 years of age (N = 2979). Diabetes predicted higher hip, whole body, and volumetric spine BMD, and lower spine bone volume, independent of body composition and fasting insulin. Introduction: The purpose of this study was to determine if the association between type 2 diabetes and higher BMD observed in older white women is seen in elderly white men and blacks and to evaluate if higher BMD in diabetic individuals is accounted for by lean mass, fat mass, or fasting insulin differences. Materials and Methods: In the Health, Aging, and Body Composition Study, which included white and black well‐functioning men and women 70‐79 years of age (N = 2979), 19% of participants had diabetes at baseline. Of those with diabetes, 57% were men, and 62% were black. Multivariate linear regression models examined independent effects of diabetes, lean mass, fat mass, visceral fat, and fasting insulin on BMD and bone volume while adjusting for relevant covariates. Results and Conclusions: Fasting insulin, visceral fat, and volumetric spine BMD, assessed by CT, and lean mass, fat mass, and total hip and whole body BMD, assessed by DXA, were higher (p ≤ 0.05 for all) for those with diabetes. Hip BMD was higher in white men (0.99 ± 0.14 versus 0.93 ± 0.14 g/cm2, p < 0.001), black men (1.06 ± 0.17 versus 1.00 ± 0.15 g/cm2, p < 0.001), white women (0.83 ± 0.13 versus 0.76 ± 0.13 g/cm2, p < 0.001), and black women (0.90 ± 0.15 versus 0.85 ± 0.15 g/cm2, p < 0.001) with diabetes compared with those without diabetes, although the relationship was attenuated by body composition. In multiple regression models, diabetes was an independent predictor of higher hip, whole body, and volumetric spine BMD in all participants (p ≤ 0.001), but lower spine volume (p = 0.01) and higher hip BMD for each race‐gender group (p ≤ 0.01). Type 2 diabetes was associated with a 4‐5% higher total hip BMD in all race‐gender groups of elderly adults, independent of body composition and fasting insulin levels.