Bone Turnover Markers in Patients with Nonalcoholic Fatty Liver Disease and/or Type 2 Diabetes during Oral Glucose and Isoglycemic Intravenous Glucose

Henrik Maagensen, Anders E. Junker, Niklas R. Jørgensen, Lise L. Gluud, Filip K. Knop, Tina Vilsbøll*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Context: Nonalcoholic fatty liver disease (NAFLD) is associated with type 2 diabetes (T2D) and vice versa, and both conditions are associated with an increased risk of fractures and altered bone turnover. Although patients with NAFLD typically suffer from decreased bone mineral density (BMD), T2D is associated with normal to high BMD. The pathophysiology is uncertain but may involve the gut-bone axis. Objective: We investigated the influence of the gut on glucose-induced changes in plasma bone turnover markers in healthy controls and patients with T2D and/or biopsy-verified NAFLD. Design: Cross-sectional cohort study. Patients: Patients with NAFLD with normal glucose tolerance, patients with NAFLD and T2D, patients with T2D without liver disease, and healthy controls. Interventions: Four-hour 50-g oral glucose tolerance test (OGTT) and an isoglycemic intravenous glucose infusion (IIGI). Main Outcome Measures: Collagen type 1 C-telopeptide (CTX), osteocalcin, procollagen type 1 N-terminal propeptide (P1NP), and parathyroid hormone. Results: Plasma glucose levels achieved during OGTTs were successfully matched on corresponding IIGI days. Patients with NAFLD and T2D exhibited similar CTX suppression during the two glucose challenges (P = 0.46) and pronounced suppression of P1NP during IIGI compared with OGTT. Conversely, remaining groups showed greater (P < 0.05) CTX suppression during OGTT and similar suppression of bone formation markers during IIGI and OGTT. Conclusions: OGTT-induced CTX suppression seems to be impaired in patients with NAFLD and T2D, but preserved in patients with either NAFLD or T2D, suggesting that coexistence of T2D and NAFLD may affect gut-bone axis.

Original languageEnglish
JournalThe Journal of Clinical Endocrinology & Metabolism
Volume103
Issue number5
Pages (from-to)2042-2049
ISSN0021-972X
DOIs
Publication statusPublished - 1. May 2018

Keywords

  • Administration, Intravenous
  • Administration, Oral
  • Adult
  • Aged
  • Biomarkers/blood
  • Blood Glucose/drug effects
  • Bone Remodeling/physiology
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2/blood
  • Female
  • Glucose Tolerance Test
  • Glucose/administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease/blood

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