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

Bone. 2017 Jun;99:14-19. doi: 10.1016/j.bone.2017.03.039. Epub 2017 Mar 16.


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 40-74years old, with average morning testosterone (done twice) of<300ng/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 (25OHD) 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 (857.3±69.0mg/cm3 vs. 828.7±96.7mg/cm3, p=0.02). Endosteal (43.9±5.8mm vs. 47.1±7.8mm, p=0.04) and periosteal (78.4±5.0mm vs. 81.3±6.5mm, p=0.02) circumferences and total area (491.0±61.0mm2 vs. 527.7±87.2mm2, p=0.02) at 38% tibia, were lower in diabetic men even after adjustments for covariates. CTX (0.25±0.14ng/ml vs. 0.40±0.19ng/ml, p<0.001) and osteocalcin (4.8±2.8ng/ml vs. 6.8±3.5ng/ml, p=0.006) were lower in diabetic men; there were no differences in sclerostin and 25OHD. 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.

Keywords: Bone; Bone geometry; Hypogonadism; T2D; Testosterone.

MeSH terms

  • Adult
  • Aged
  • Bone Density / physiology
  • Bone Remodeling / physiology*
  • Bone and Bones / anatomy & histology*
  • Bone and Bones / metabolism*
  • Collagen Type I / blood
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / metabolism*
  • Humans
  • Hypogonadism / blood
  • Hypogonadism / metabolism
  • Male
  • Middle Aged
  • Osteocalcin / blood
  • Peptides / blood
  • Sex Hormone-Binding Globulin / metabolism
  • Testosterone / blood
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood


  • Collagen Type I
  • Peptides
  • Sex Hormone-Binding Globulin
  • collagen type I trimeric cross-linked peptide
  • Osteocalcin
  • Vitamin D
  • Testosterone
  • 25-hydroxyvitamin D