The association between the baseline bone resorption marker CTX and incident dysglycemia after 4 years

Abstract

Bone is an endocrine organ involved in modulating glucose homeostasis. The role of the bone formation marker osteocalcin (OCN) in predicting diabetes was reported, but with conflicting results. No study has explored the association between baseline bone resorption activity and incident diabetes or prediabetes during follow-up. Our objective was to examine the relationship between the baseline bone resorption marker crosslinked C-telopeptide of type I collagen (CTX) and glycemic dysregulation after 4 years. This longitudinal study was conducted in a university teaching hospital. A total of 195 normal glucose tolerant (NGT) women at baseline were invited for follow-up. The incidence of diabetes and prediabetes (collectively defined as dysglycemia) was recorded. A total of 128 individuals completed the 4-year study. The overall conversion rate from NGT to dysglycemia was 31.3%. The incidence of dysglycemia was lowest in the middle tertile [16.3% (95% confidence interval (CI), 6.8%–30.7%)] compared with the lower [31.0% (95% CI, 17.2%–46.1%)] and upper [46.5% (95% CI, 31.2%–62.6%)] tertiles of CTX, with a significant difference seen between the middle and upper tertiles (P=0.002 5). After adjusting for multiple confounding variables, the upper tertile of baseline CTX was associated with an increased risk of incident dysglycemia, with an odds ratio of 7.09 (95% CI, 1.73–28.99) when the middle tertile was the reference. Osteoclasts actively regulate glucose homeostasis in a biphasic model that moderately enhanced bone resorption marker CTX at baseline provides protective effects against the deterioration of glucose metabolism, whereas an overactive osteoclastic function contributes to an increased risk of subsequent dysglycemia.

Biomarkers: CTX is a potential marker for diabetes

Measuring levels of a biomarker commonly used to determine bone health shows promise as a predictor for diabetes risk. Disruptions to bone regeneration and resorption may alter glucose homeostasis, possibly aiding the development of diabetes. Ting-ting Liu at Shanghai Jiao Tong University School of Medicine, China, and co-workers examined levels of the bone resorption marker CTX to determine if they correlate with the onset of diabetes. The team analyzed samples from 128 patients over a period of 4 years, during which 31% of the cohort developed abnormal glucose levels (dysglycemia). The correlation between CTX and dysglycemia was U-shaped, meaning that patients with elevated or low CTX had an increased risk of developing prediabetes or diabetes. Mid-range CTX levels indicated a healthier outlook. Larger-scale studies will help to clarify whether CTX is a viable marker of diabetes.

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