A Comparative Study To Correlate The Levels Of Serum Zinc, Calcium, Phosphorous And Alkaline Phosphatase In Post Menopausal Women With Osteoporosis: Diabetics Versus Non-Diabetics

Abstract

Background and Objectives: ABSTRACT Osteoporosis in postmenopausal women is a public health problem associated with significant morbidity and mortality. Patients with Diabetes mellitus are at increased risk of osteoporosis related fractures. Low BMD has been consistently observed in T1DM, but it is not so in T2DM which is associated with normal or higher BMD levels. Zinc is an essential trace element having a role in collagen metabolism and its levels are shown to be altered in DM. This study was undertaken to compare the levels of serum zinc with other bone parameters like serum calcium, phosphorous and alkaline phosphatase between diabetic and non diabetic postmenopausal women to see whether these parameters are altered in diabetes and if they influence BMD in postmenopausal women with diabetic osteoporosis. Materials and methods 30 diabetic and 30 age matched non-diabetic DEXA confirmed cases of postmenopausal women with osteoporosis were included in the study. Serum zinc, calcium, phosphorous and alkaline phosphatase levels were estimated in diabetic women with osteoporosis and the levels were compared with non diabetic women. Serum zinc was analysed in AAS and other parameters using standard biochemical methods. Mean and Standard Deviation of the parameters of the two groups were computed and compared by unpaired student’s t test. Relationship between the variables was measured by Karl Pearson’s correlation co-efficient. A statistical significance is set at 5% level of significance ( p<0.05) . v Results All the 30 diabetic women belonged to type 2 category. The mean serum zinc, calcium, phosphorous and alkaline phosphatase levels for diabetics were 62.4±13.35 µg/dL, 8.22±1.13 mg/dL, 4.53±0.83 mg/dL and 92.47±22.65 IU/L and for non diabetics 68.2±13.86 µg/dL, 8.4±1.27 mg/dL, 4.32±0.92 mg/dL and 87.23±14.66 IU/L respectively. The mean serum zinc and calcium levels were lower and mean serum phosphorous and ALP levels were higher in case of diabetics as compared to non diabetics but there was no significant difference between the values in the two groups ( P>0.05 ) . Diabetics had a significantly lower mean age at menopause ( 46±1.78 years ) compared to non diabetics ( 47.20±1.42 years ) p<0.01. Diabetics had a higher mean BMD ( 0.83±0.06 g/cm 2 ) than non- Diabetics ( 0.79±0.09 g/cm statistically significant ( p=0.0661) . However the t-scores were significantly higher in case of diabetic ( -2.84±0.42 ) women compared to non diabetics ( -3.22±0.74 ) p<0.05. BMD in diabetics showed a significant positive correlation with BMI ( p<0.05 ) , Zinc ( p<0.001) and calcium ( p<0.05) while it showed a significant positive correlation with Zn ( p<0.01) and Ca ( p<0.001) and a significant negative correlation with P ( p<0.05) and ALP ( p<0.001) in non- diabetics. Diabetics had a significantly higher weight ( p<0.001) and BMI ( p<0.05) than non-diabetics. BMI of diabetics showed a significant positive correlation with zinc ( p<0.05) . Interpretation and conclusion: vi 2 ) but it was not Our study suggests that serum zinc, calcium, phosphorous and alkaline phosphatase are not significantly altered in type 2 diabetic postmenopausal women with osteoporosis as compared to non diabetic women with postmenopausal osteoporosis when overt nephropathy is excluded. Type 2 DM mellitus women may be at risk of early menopause. High BMI in type 2 DM may contribute to high BMD and may be a protective factor against zincuria and hypercalciurea as well. Medications with oral hypoglycaemic drugs and/or insulin may reduce the zincuria and hypercalciurea that may accompany diabetes. However to what extent it can prevent diabetes related fractures cannot be told as fractures in type 2 DM are attributable to poor bone quality rather than BMD. More studies are required in this arena on the role of zinc in postmenopausal women with Diabetic Osteoporosis