Markers of Bone Turnover May Predict Risk for Incident Diabetes in Postmenopausal Women

Spongy bone tissue affected by osteoporosis
Spongy bone tissue affected by osteoporosis
Low bone turnover may be a sign of higher incidence of diabetes.

Low osteocalcin (OC) and C-telopeptide of type 1 collagen (CTX) levels in postmenopausal women are associated with an increased risk for insulin resistance and incident diabetes, according to a recent study published in Diabetes Care

The analysis included 1455 postmenopausal women, (mean [SD] age 74.6 [5.0]) who were part of the population-based Cardiovascular Health Study. These participants underwent assessments for demographic data, lifestyle, and medical history, including medications, laboratory, and diagnostic testing. 

Total serum osteocalcin and C-telopeptide of type 1 collagen levels were calculated utilizing multiple linear regression, and Multivariable Cox proportional hazard models were used to examine the longitudinal association of osteocalcin and C-telopeptide of type 1 collagen in incident diabetes—defined by follow-up glucose measures, medications, and ICD-9 codes.

Continuous levels of osteocalcin were significantly inversely related to insulin resistance (P =.004). Continues C-telopeptide of type 1 collagen levels, though marginally insignificant, showed a similar relationship to insulin resistance (P =.051). At median follow-up of 11.5 years, 196 cases of incident diabetes were discovered among the participants. After adjustment, both biomarkers still showed inverse associations with incident diabetes (osteocalcin: hazard ratio 0.85 per SD [95% CI, 0.71–1.02; P =.075]; C-telopeptide of type 1 collagen: 0.82 per SD [955 CI, 0.69–0.98; P =.031]).

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Researchers concluded that osteocalcin and C-telopeptide of type 1 collagen are strongly associated with insulin resistance and incident diabetes in late postmenopausal women. The findings also suggest that bone health may be a factor in glucose maintenance in the same postmenopausal demographic.

This study was funded by the National Heart, Lung, and Blood Institute, with additional contributions from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.


Massera D, Biggs ML, Walker MD, et el. Biochemical markers of bone turnover and risk of incident diabetes in older women: The Cardiovascular Health Study [published online July 12, 2018]. Diabetes Care. doi: 10.2337/dc18-0849.