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Bone Mineral Density in Non-Insulin-Dependent Diabetes Mellitus
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TO THE EDITOR:
Dr. van Daele and colleagues [1] have provided further evidence to support an association between non–insulin-dependent diabetes mellitus and increased bone mineral density. They speculate that this is an anabolic effect of insulin but did not acknowledge the information on bone biochemistry and bone histomorphometry that suggests a reduction in bone formation rather than an anabolic effect [2-5]. A reduction in bone turn-over could account both for patients' failure to accumulate bone during bone growth (yielding a low bone density in patients with insulin-dependent diabetes mellitus) and also for diminution of age-related bone loss in patients with non–insulin-dependent diabetes mellitus—a unifying hypothesis for the effect of diabetes mellitus on bone [3-5].
A state of low bone turnover facilitates the accumulation of microdamage in bone and thus increases the risk for stress fractures. We have speculated about whether this microdamage might predispose patients with diabetes mellitus to foot fractures [3-5]. Dr. van Daele and associates found a lower prevalence of nonvertebral fractures in women than in controls. This lower prevalence was not seen with men. The authors mention that the ankle and foot were the most common sites of fracture in men and the second most common sites in women. Did these patients have stress fractures? Did stress fractures in the foot occur more frequently than in controls?
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
