High serum adiponectin level is a risk factor for osteoporosis in patients with diabetes mellitus type II

Komang Arie Trysna Andika; Putu Astawa; I Wayan Suryanto Dusak; I Ketut Siki Kawiyana; Ketut Gede Mulyadi Ridia; I Ketut Suyasa; I Gede Eka Wiratnaya

doi:10.15562/medicina.v52i1.1039

High serum adiponectin level is a risk factor for osteoporosis in patients with diabetes mellitus type II

Komang Arie Trysna Andika ,

Putu Astawa ,

I Wayan Suryanto Dusak ,

I Ketut Siki Kawiyana ,

Ketut Gede Mulyadi Ridia ,

I Ketut Suyasa ,

I Gede Eka Wiratnaya ,

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DOI: https://doi.org/10.15562/medicina.v52i1.1039 |
Published: 2021-04-01

Abstract

Introduction: Osteoporosis is the most common metabolic bone disorder and the incidence is increasing annually. Diabetes mellitus as one of the most common metabolic disease, also can caused secondary osteoporosis. Adiponectin, a relatively new hormone, are known having a good correlation with DM and improving the insulin resistant. In contrast, Adiponectin still have a controversial effect for osteoporosis. Although some study already conducted, but it still inconclusive and also varies in result between different ethnic group.

Methods: This study is an analytical study using case control design to prove that high serum adiponectin level is a risk factor for osteoporosis in diabetes mellitus type II patients. ROC curve analysis was performed to determine the cut-off value of adiponectin level as a risk factor for osteoporosis in patients with DM type II. After the cut-off value is determined, risk factor analysis was performed using 2x2 cross tabulation, in order to count the Odds Ratio (OR).

Results: In the study, the average level of Adiponectin in the Osteoporosis group was 8.83±1.78 mg / mL, as for the non-Osteoporosis group was 6.43 ± 1.77 mg / mL, indicating significant difference (T-test, p = 0.001). Through ROC curve analysis, it was found that adiponectin level of equal or higher than 7.30 mcg/mL has a sensitivity of 74% and specificity of 70% in determining the risk for osteoporosis in patients with DM type II. Chi-square test showed a value of P= 0,003 (P<0,05), indicating that adiponectin level of >7.3 mcg/mL is a risk factor for osteoporosis in patients with DM type II.

Conclusion: In patients with type 2 DM, a high serum adiponectin level is a risk factor for osteoporosis.

Pendahuluan: Osteoporosis adalah kelainan tulang metabolik yang paling umum dan insidensinya meningkat setiap tahun. Diabetes mellitus sebagai salah satu penyakit metabolik yang paling umum, juga dapat menyebabkan osteoporosis sekunder. Adiponectin, hormon yang relatif baru, diketahui memiliki korelasi yang baik dengan DM dan meningkatkan resistensi insulin. Sebaliknya, Adiponectin masih memiliki efek kontroversial untuk osteoporosis. Meskipun beberapa penelitian sudah dilakukan, tetapi masih belum dapat disimpulkan dan juga bervariasi dalam hasil antara kelompok etnis yang berbeda.

Metode: Penelitian ini adalah studi analitik menggunakan desain case control untuk membuktikan bahwa kadar adiponektin serum tinggi merupakan faktor risiko osteoporosis pada pasien diabetes mellitus tipe II. Analisis kurva ROC dilakukan untuk menentukan nilai cut-off level adiponectin sebagai faktor risiko osteoporosis pada pasien DM tipe II. Setelah nilai cut-off ditentukan, analisis faktor risiko dilakukan menggunakan tabulasi silang 2x2, untuk menghitung Odds Ratio (OR).

Hasil: Dalam penelitian ini, tingkat rata-rata Adiponectin pada kelompok Osteoporosis adalah 8,83 ± 1,78 mg / mL, sedangkan untuk kelompok non-Osteoporosis adalah 6,43 ± 1,77 mg / mL, menunjukkan perbedaan yang signifikan (T-test, p=0,001). Melalui analisis kurva ROC, ditemukan bahwa kadar adiponektin yang sama atau lebih tinggi dari 7,30 mcg / mL memiliki sensitivitas 74% dan spesifisitas 70% dalam menentukan risiko osteoporosis pada pasien DM tipe II. Uji Chi-square menunjukkan nilai P=0,003 (P<0,05), menunjukkan bahwa tingkat adiponectin >7,3 mcg / mL adalah faktor risiko osteoporosis pada pasien DM tipe II.

Kesimpulan: Pada pasien DM tipe 2, kadar adiponektin serum yang tinggi merupakan faktor risiko osteoporosis.

References

Tandra H. Osteoporosis: Mengenal, Mengatasi, dan Mencegah Tulang Keropos. Jakarta: Gramedia Pustaka Utama; 2009.
Kementerian Kesehatan RI. Data & Kondisi Penyakit Osteoporosis di Indonesia. Infodatin (Pusat Data dan Inf Kementeri Kesehat RI). 2015;
Wardhana W, Heri-Nugroho H-N, Hapsari R. Faktor – Faktor Risiko Osteoporosis Pada Pasien Dengan Usia Di Atas 50 Tahun. J Kedokt Diponegoro. 2012;
Williams GA, Wang Y, Callon KE, Watson M, Lin JM, Lam JBB, et al. In vitro and in vivo effects of adiponectin on bone. Endocrinology. 2009;150(8):3603–10.
Richards JB, Valdes AM, Burling K, Perks UC, Spector TD. Serum adiponectin and bone mineral density in women. J Clin Endocrinol Metab. 2007;92(4):1517–23.
Kanazawa I, Yamaguchi T, Yamamoto M, Yamauchi M, Yano S, Sugimoto T. Relationships between serum adiponectin levels versus bone mineral density, bone metabolic markers, and vertebral fractures in type 2 diabetes mellitus. Eur J Endocrinol. 2009;
King GA, Deemer SE, Thompson DL. Relationship between leptin, adiponectin, bone mineral density, and measures of adiposity among pre-menopausal hispanic and caucasian women. Endocr Res. 2010;
Al-Osami MH, Hameed EK. Serum adiponectin level in osteoporotic postmenopausal women with type 2 diabetes mellitus. Diabetes Metab Syndr Clin Res Rev. 2018;12(6):939–42.
Prakash S, Jatti RS, Ghagane SC, Jali SM, Jali M V. Prevalence of osteoporosis in type 2 diabetes mellitus patients using dual energy X-ray absorptiometry (DEXA) scan. Int J Osteoporos Metab Disord. 2017;
Jang M, Kim H, Lea S, Oh S, Kim JS, Oh B. Effect of duration of diabetes on bone mineral density: A population study on East Asian males. BMC Endocr Disord. 2018;
Komorita Y, Iwase M, Fujii H, Ohkuma T, Ide H, Jodai-Kitamura T, et al. Serum adiponectin predicts fracture risk in individuals with type 2 diabetes: the Fukuoka Diabetes Registry. Diabetologia. 2017;
Berner HS, Lyngstadaas SP, Spahr A, Monjo M, Thommesen L, Drevon CA, et al. Adiponectin and its receptors are expressed in bone-forming cells. Bone. 2004;
Lubkowska A, Dobek A, Mieszkowski J, Garczynski W, Chlubek D. Adiponectin as a Biomarker of Osteoporosis in Postmenopausal Women: Controversies. Dis Markers. 2014;

[1] Tandra H. Osteoporosis: Mengenal, Mengatasi, dan Mencegah Tulang Keropos. Jakarta: Gramedia Pustaka Utama; 2009.

[2] Kementerian Kesehatan RI. Data & Kondisi Penyakit Osteoporosis di Indonesia. Infodatin (Pusat Data dan Inf Kementeri Kesehat RI). 2015;

[3] Wardhana W, Heri-Nugroho H-N, Hapsari R. Faktor – Faktor Risiko Osteoporosis Pada Pasien Dengan Usia Di Atas 50 Tahun. J Kedokt Diponegoro. 2012;

[4] Williams GA, Wang Y, Callon KE, Watson M, Lin JM, Lam JBB, et al. In vitro and in vivo effects of adiponectin on bone. Endocrinology. 2009;150(8):3603–10.

[5] Richards JB, Valdes AM, Burling K, Perks UC, Spector TD. Serum adiponectin and bone mineral density in women. J Clin Endocrinol Metab. 2007;92(4):1517–23.

[6] Kanazawa I, Yamaguchi T, Yamamoto M, Yamauchi M, Yano S, Sugimoto T. Relationships between serum adiponectin levels versus bone mineral density, bone metabolic markers, and vertebral fractures in type 2 diabetes mellitus. Eur J Endocrinol. 2009;

[7] King GA, Deemer SE, Thompson DL. Relationship between leptin, adiponectin, bone mineral density, and measures of adiposity among pre-menopausal hispanic and caucasian women. Endocr Res. 2010;

[8] Al-Osami MH, Hameed EK. Serum adiponectin level in osteoporotic postmenopausal women with type 2 diabetes mellitus. Diabetes Metab Syndr Clin Res Rev. 2018;12(6):939–42.

[9] Prakash S, Jatti RS, Ghagane SC, Jali SM, Jali M V. Prevalence of osteoporosis in type 2 diabetes mellitus patients using dual energy X-ray absorptiometry (DEXA) scan. Int J Osteoporos Metab Disord. 2017;

[10] Jang M, Kim H, Lea S, Oh S, Kim JS, Oh B. Effect of duration of diabetes on bone mineral density: A population study on East Asian males. BMC Endocr Disord. 2018;

[11] Komorita Y, Iwase M, Fujii H, Ohkuma T, Ide H, Jodai-Kitamura T, et al. Serum adiponectin predicts fracture risk in individuals with type 2 diabetes: the Fukuoka Diabetes Registry. Diabetologia. 2017;

[12] Berner HS, Lyngstadaas SP, Spahr A, Monjo M, Thommesen L, Drevon CA, et al. Adiponectin and its receptors are expressed in bone-forming cells. Bone. 2004;

[13] Lubkowska A, Dobek A, Mieszkowski J, Garczynski W, Chlubek D. Adiponectin as a Biomarker of Osteoporosis in Postmenopausal Women: Controversies. Dis Markers. 2014;

High serum adiponectin level is a risk factor for osteoporosis in patients with diabetes mellitus type II

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References

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