J Bone Metab.  2018 May;25(2):123-132. 10.11005/jbm.2018.25.2.123.

Association of Insulin Resistance with Lower Bone Volume and Strength Index of the Proximal Femur in Nondiabetic Postmenopausal Women

• Yang J
• Hong N
• Shim JS
• Rhee Y
• Kim HC

• KMID: 2413374
• DOI: http://doi.org/10.11005/jbm.2018.25.2.123

Abstract

BACKGROUND
Type 2 diabetes mellitus is associated with an increased risk of osteoporotic fracture despite relatively preserved bone mineral density (BMD). Although this paradox might be attributed to the influence of insulin resistance (IR) on bone structure and material properties, the association of IR with femur bone geometry and strength indices remains unclear.
METHODS
Using data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort study, we conducted a cross-sectional analysis among nondiabetic postmenopausal women. IR was estimated using the homeostasis model assessment of IR (HOMA-IR). Compartment-specific volumetric BMD (vBMD) and bone volume of proximal femur were measured using quantitative computed tomography. The compressive strength index (CSI), section modulus (Z), and buckling ratio of the femoral neck were calculated as bone strength indices.
RESULTS
Among 1,008 subjects (mean age, 57.3 years; body mass index [BMI], 23.6 kg/m²), BMI, waist circumference, and vBMD of the femoral neck and total hip increased in a linear trend from the lowest ( < 1.37) to highest (≥2.27) HOMA-IR quartile (P < 0.05 for all). The HOMA-IR showed an independent negative association with total bone volume (standardized β=−0.12), cortical volume (β=−0.05), CSI (β=−0.013), and Z (β=−0.017; P < 0.05 for all) of the femoral neck after adjustment for age, weight, height, physical activity, and vitamin D and high-sensitivity C-reactive protein levels. However, the association between HOMA-IR and vBMD was attenuated in the adjusted model (femoral neck, β=0.94; P=0.548).
CONCLUSIONS
Elevated HOMA-IR was associated with lower cortical bone volume and bone strength indices in nondiabetic postmenopausal women, independent of age and body size.

Keyword

Bone density; Femur; Insulin resistance; Osteoporosis; Postmenopause

MeSH Terms

Body Mass Index
Body Size
Bone Density
C-Reactive Protein
Cohort Studies
Compressive Strength
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Female
Femur Neck
Femur*
Hip
Homeostasis
Humans
Insulin Resistance*
Insulin*
Metabolic Diseases
Motor Activity
Neck
Osteoporosis
Osteoporotic Fractures
Postmenopause
Vitamin D
Waist Circumference
C-Reactive Protein
Insulin
Vitamin D

Figure

• 

  Fig. 1 Study flow diagram. HbA1c, hemoglobin A1c; QCT, quantitative computed tomography.

• 

  Fig. 2 Standardized difference (in standard deviation [SD] units±95% confidence interval) in quantitative computed tomography-derived bone volume and density at proximal femur for subjects in the top quartiles of homeostasis model assessment of insulin resistance (HOMA-IR) vs. lower quartiles after adjustment for age, weight, and height. Dashed line indicates the mean of the bottom two quartiles. The mean difference between the groups were expressed in SD scores as divided by the SD of the bottom two quartile group. Asterisk (*) indicated P<0.05 for the difference between the top and bottom two quartiles. vBMD, volumetric bone mineral density.

• 

  Fig. 3 Standardized difference (in standard deviation [SD] units±95% confidence interval) in quantitative computed tomography-derived bone geometry parameters at femur according to homeostasis model assessment of insulin resistance (HOMA-IR) quartiles. Dashed line indicates the mean value of the subjects in lowest quartile after adjustment for age, weight, and height. The mean difference between the groups were expressed in SD scores as divided by the SD of the lowest quartile group. Asterisk (*) indicated P<0.05 as compared with the lowest quartile as reference group. Q, quartile; CSI, compressive strength index; Z, section modulus; BR, buckling ratio.

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