Bone Mineral Density in Prediabetic Men (Korean Diabetes J 2010;34:294-302)

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Diabetes Metab J. 2010;34(6):386-387
Publication date (electronic) : 2010 December 31
doi :
Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
Corresponding author: Bon Jeong Ku. Department of Internal Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea.

Thank you for your interest in this study, the results of which showed that there is no substantial difference in bone mineral density (BMD) T-score measured using a quantitative ultrasound (QUS) between control and prediabetic men between 40 and 70 years of age [1].

The calcaneal QUS is an evaluation tool used to detect osteoporosis and risk of fractures based on measurements of the foot. It is very useful for clinical application due to its low-cost and high-mobility [2]. Generally, broadband ultrasound attenuation (BUA) and the speed of sound (SOS) are measured and used to calculate BMD. However, in this study, there was a limitation for that data which cannot be presented through a loss of data for BUA and SOS results. Dual-energy X-ray absorptiometry (DXA) has been used as a method to measure BMD [3]. However, due to radiation exposure or mobility restrictions, different examination methods are used to evaluate BMD and risk of fractures depending on the situation. In the case of epidemiologic studies like this one, QUS is used to determine BMD. There have been many reports that the t-scores derived from QUS measurements are correlated with the t-scores derived from DXA measurements [4-6]. In addition, the results of QUS measurements have been expressed as BMD in several studies [4,7,8]. Although DXA is the golden standard for measuring BMD, 100% accuracy in reflecting the real physiological state has not been achieved. Although 't-score assessed by QUS' is a more accurate representation of our measurement than is BMD, we can use BMD as broader meaning when considering the correlation between QUS and DXA.

It is a well known fact that insulin has an anabolic effect on bone cells [9,10]. As noted in your comment, the correlation between insulin and BMD showed confusing results in this study [1]. As indicated, statistical limitations or non-linear relationships are likely to be seen. The BMD in type 2 diabetes patients have reported conflicting results according to the study subjects or age groups [11-13]. Because we targeted the aforementioned prediabetic patient group, the BMD in diabetes patients could be projected through this study; however, there was no observed significant difference between prediabetic subjects and the control group.

The participants in this study were males between 40 and 70 years of age. Many factors that have an effect on BMD were not considered in this study; therefore, we believe that a prospective control study is required to overcome this limitation. This study is the first to analyze BMD in Korean prediabetic patients, and the results are expected to be clinically useful.

We would like to thank you once again for your comments and interest in this study.


1. Lee JH, Lee YH, Jung KH, Kim MK, Jang HW, Kim TK, Kim HJ, Jo YS, Shong M, Lee TY, Ku BJ. Bone mineral density in prediabetic men. Korean Diabetes J 2010;34:294–302. 21076577.
2. Hans D, Fuerst T, Duboeuf F. Quantitative ultrasound bone measurement. Eur Radiol 1997;7(Suppl 2):S43–S50. 9126458.
3. El Maghraoui A, Roux C. DXA scanning in clinical practice. QJM 2008;101:605–617. 18334497.
4. Rhee Y, Lee J, Jung JY, Lee JE, Park SY, Kim YM, Lee S, Choi HS, Kim SH, Lim SK. Modifications of T-scores by quantitative ultrasonography for the diagnosis of osteoporosis in Koreans. J Korean Med Sci 2009;24:232–236. 19399263.
5. Guglielmi G, de Terlizzi F. Quantitative ultrasound in the assessment of osteoporosis. Eur J Radiol 2009;71:425–431. 19651483.
6. Baroncelli GI. Quantitative ultrasound methods to assess bone mineral status in children: technical characteristics, performance, and clinical application. Pediatr Res 2008;63:220–228. 18287958.
7. Lin JD, Chen JF, Chang HY, Ho C. Evaluation of bone mineral density by quantitative ultrasound of bone in 16,862 subjects during routine health examination. Br J Radiol 2001;74:602–606. 11509395.
8. Frost ML, Blake GM, Fogelman I. Can the WHO criteria for diagnosing osteoporosis be applied to calcaneal quantitative ultrasound? Osteoporos Int 2000;11:321–330. 10928222.
9. Hahn TJ, Westbrook SL, Sullivan TL, Goodman WG, Halstead LR. Glucose transport in osteoblast-enriched bone explants: characterization and insulin regulation. J Bone Miner Res 1988;3:359–365. 2463740.
10. Conover CA, Lee PD, Riggs BL, Powell DR. Insulin-like growth factor-binding protein-1 expression in cultured human bone cells: regulation by insulin and glucocorticoid. Endocrinology 1996;137:3295–3301. 8754754.
11. Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes: a meta-analysis. Osteoporos Int 2007;18:427–444. 17068657.
12. Rakel A, Sheehy O, Rahme E, LeLorier J. Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab 2008;34:193–205. 18308607.
13. de Liefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 2005;16:1713–1720. 15940395.

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