Abstract

Objective: Patients with type 2 diabetes mellitus (T2DM) are known to have an increased risk for fracture compared to non-T2DM controls, despite their higher bone mineral density (BMD). We previously showed that serum pentosidine, one of the advanced glycation end-products (AGEs), was associated with prevalent vertebral fractures (VFs) in T2DM. The involvement of the endogenous secretory receptor for AGEs (esRAGE) in VFs in T2DM, however, is still unknown.

Research Design and Methods: We compared parameters including esRAGE, pentosidine, and BMD in Japanese T2DM patients (137 men over 50 years old and 140 postmenopausal women) with and without VFs.

Results: The esRAGE/pentosidine ratio in T2DM patients with VFs was significantly lower than in those without VFs (men: 7.1 ± 2.8 vs. 9.4 ± 6.2, P = 0.013, respectively; women: 4.7 ± 2.7 vs. 8.2 ± 5.4, P < 0.001, respectively). Multivariate logistic regression analysis adjusted for age, height, weight, HbA_1c, serum creatinine, duration of diabetes, therapeutic agents, diabetic complications, osteoporotic risk factors, and lumbar BMD identified the serum esRAGE level and esRAGE/pentosidine ratio as factors associated with the presence of VFs, independent of BMD in men [odds ratio (OR) 0.46 (95% CI 0.25–0.84), P = 0.012, and OR 0.34 (0.15–0.76), P = 0.009, respectively] and in women [OR 0.32 (0.16–0.67), P = 0.002 and OR 0.14 (0.04–0.43), P = 0.001, respectively].

Conclusions: Conclusions: These results show that serum esRAGE level and esRAGE/pentosidine ratio are more useful than BMD for assessing the risk of VFs in T2DM patients.