Journal List > Endocrinol Metab > v.27(4) > 1085973

Lee, Lee, Han, Kim, Lee, and Kim: The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes

초록

Backgroud

Patients with type 2 diabetes are known to have an increased risk for osteoporotic fractures compared with non-dia-betic subjects. We investigated whether the serum endogenous secretory receptor for advanced glycation end products (esRAGE) or pentosidine was associated with prevalent vertebral fractures in patients with type 2 diabetes.

Methods

We enrolled 140 patients with type 2 diabetes mellitus (73 men aged 50 or older and 67 postmenopausal women). Lateral X-ray films of the spine revealed prevalent vertebral fractures. The serum concentration of esRAGE and pentosidine were measured.

Results

The mean age of all patients was 66.2 ± 6.5 years and 22% of patients had prevalent vertebral fractures. Serum pentosidine levels were similar between those with and without vertebral fractures. There were no significant correlations between serum es-RAGE levels and age, body mass index, duration of diabetes, and hemoglobin A1c. However, patients with moderate or severe vertebral fractures have a lower esRAGE level compared to those without after adjusting for age and gender (0.33 ± 0.12 ng/mL vs. 0.24 ± 0.03 ng/mL, P < 0.05). Logistic regression analysis demonstrated that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures (odds ratio, 16.6; 95% confidence interval, 1.4-198.5) than patients in the highest tertile.

Conclusion

These results revealed that a low esRAGE level was independently associated with moderate or severe vertebral fractures in type 2 diabetic patients. (Endocrinol Metab 27:289-294, 2012)

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Fig. 1.
Serum endogenous secretory receptor for advanced glycation end products (esRAGE) concentration in type 2 diabetic patients with or without vertebral fractures after adjusting for age and gender. Patients with moderate or severe vertebral fractures showed significantly lower esRAGE levels compared to those without. ∗Age, gender adjusted P < 0.05.
enm-27-289f1.tif
Table 1.
Baseline characteristics of study patients according to esRAGE tertile
Variable esRAGE P value
Tertile 1 (lowest) Tertile 2 (middle) Tertile 3 (highest)
Age (yr) 65.1 ± 5.2 67.4 ± 7.4 66.0 ± 6.5 0.202
Female sex (no, %) 22 (46.8) 23 (48.9) 22 (47.8) 0.921
Body mass index (kg/m2) 24.7 ± 3.1 25.6 ± 2.7 25.1 ± 2.6 0.344
Duration of diabetes (yr) 11.0 ± 6.6 13.3 ± 8.6 11.7 ± 8.7 0.396
Fasting glucose (mg/dL) 153.8 ± 47.3 148.2 ± 65.5 154.9 ± 66.5 0.851
HbA1c (%) 7.5 ± 1.4 7.4 ± 1.3 7.7 ± 1.3 0.755
AST (IU/L) 23.4 ± 10.6 25.6 ± 13.2 22.5 ± 6.4 0.329
ALT (IU/L) 21.3 ± 10.5 26.7 ± 20.1 22.4 ± 8.7 0.163
Total cholesterol (mg/dL) 157.6 ± 34.6 166.1 ± 35.5 154.5 ± 40.2 0.308
Triglyceride (mg/dL) 138.0 ± 76.8 147.8 ± 74.9 153.6 ± 90.0 0.674
HDL-C (mg/dL) 58.2 ± 74.4 49.5 ± 19.5 45.9 ± 15.2 0.435
Creatinine (mg/dL) 0.98 ± 0.17 1.02 ± 0.18 1.05 ± 0.17 0.142
esRAGE (ng /mL) 0.19 ± 0.03 0.30 ± 0.03 0.47 ± 0.09 < 0.001
Pentosidine (ng/mL) 11.4 ± 6.6 10.8 ± 3.9 10.7 ± 3.7 0.754
Vertebral fractures (%)       0.011
None 36 (76.6) 39 (83.0) 43 (93.5)  
Mild 2 (4.3) 3 (6.4) 2 (4.3)  
Moderate or severe 9 (19.1) 5 (10.6) 1 (2.2)  
Smoking       0.272
Ex-smoker 12 (25.5) 14 (30.0) 17 (36.9)  
Current smoker 3 (6.4) 7 (14.9) 4 (8.7)  
Alcohol 8 (17) 9 (19.1) 2 (4.3) 0.077
Regular exercise 26 (55.3) 24 (51.1) 32 (59.6) 0.230
Medication        
Oral hypoglycemic agents 46 (97.9) 47 (100) 45 (97.8) 0.990
Use of thiazolidinedione 9 (19.1) 7 (4.3) 3 (6.5) 0.042
Use of Insulin 8 (17.0) 9 (19.1) 9 (19.6) 0.753
Statin 33 (70.2) 29 (61.7) 30 (65.2) 0.610
Hypertension 32 (68.1) 33 (70.2) 34 (73.9) 0.539
Coronary artery occlusive disease 6 (12.8) 6 (12.8) 7 (15.2) 0.525
Stroke 12 (25.5) 4 (8.5) 7 (15.2) 0.195

Values are expressed as mean ± SD or number (%).

ALT, alanine aminotransferase; AST, aspartate aminotransferase; esRAGE, endogenous secretory receptor for advanced glycation end products; HbA1c, hemoglobin A1c; HDL-C, high density lipoprotein cholesterol.

Table 2.
Simple regression analysis between esRAGE level and various param-eters
Parameter r P value
Age (yr) 0.145 0.087
BMI (kg/m2) -0.002 0.978
Serum creatinine (mg/dL) 0.093 0.275
Fasting plasma glucose (mg/dL) -0.113 0.186
HbA1c (%) 0.034 0.708
Duration of diabetes (yr) 0.090 0.297
Total cholesterol -0.017 0.846
Pentosidine -0.103 0.224

BMI, body mass index; esRAGE, endogenous secretory receptor for advanced glycation end products; HbA1c, hemoglobin A1c.

Table 3.
Association between esRAGE status and the presence of moderate or severe vertebral fractures in type 2 diabetic patients
esRAGE Model 1 Model 2 Model 3
1st tertile (lowest) 12.0 11.9 16.6
(1.4-102.0) (1.3-107.8) (1.4-198.5)
2nd tertile (middle) 5.0 6.4 6.5
(0.6-45.4) (0.7-60.5) (0.5-76.1)
3rd tertile (highest) Reference group Reference group Reference group

Model 1, independent variables were adjusted for age and sex; Model 2, model 1 additionally adjusted for duration of diabetes, alcohol, and smoking; Model 3, model 2 additionally adjusted for body mass index, stroke, coronary artery occlusive disease, and use of thiazolidinedione.

P < 0.05 vs. reference group.

esRAGE, endogenous secretory receptor for advanced glycation end products.

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