ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2014
Insulin resistance and bone strength: findings from the study of midlife in the United States.
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
68 citing papers in PubMed, 1 synthesis or guideline pooled it, 108 citations in OpenAlex.
- A systematic review of the association between insulin resistance surrogate indices and bone mineral density.Frontiers in endocrinology · 2024Pooled it
- The effect of metformin versus placebo in combination with insulin analogues on bone mineral density and trabecular bone score in patients with type 2 diabetes mellitus: a randomized placebo-controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Trial
- Does Visceral or Subcutaneous Fat Influence Peripheral Cortical Bone Strength During Adolescence? A Longitudinal Study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2018Trial
- Association of insulin resistance and fracture risk in the Osteoporotic Fractures in Men (MrOS) cohort.Journal of the Endocrine Society · 2026Article
- TyG-BMI as a Marker of Metabolic Status and Its Association with Bone Quality and Mineral Metabolism: A Sex-Specific Analysis.Journal of clinical medicine · 2026Article
- The impact of obesity on bone health: molecular pathways, metabolic interactions, and associated pathologies.International journal of obesity (2005) · 2026Review
- A Review of the Relationship Between Insulin and Bone Health.Biomedicines · 2025Review
- Fracture Risk Assessment in Metabolic Syndrome in Terms of Secondary Osteoporosis Potential. A Narrative Review.Calcified tissue international · 2025Review
- The Impact of Body Mass Index and Benign Prostatic Hyperplasia on Bone Health of Middle-Aged and Older Men.Obesity science & practice · 2025Article
- Article
- Risk factors for osteoporosis in elderly patients with type 2 diabetes: A protocol for systematic review and meta-analysis.PloS one · 2025Article
- The correlation between TyG-BMI and the risk of osteoporosis in middle-aged and elderly patients with type 2 diabetes mellitus.Frontiers in nutrition · 2025Article
- Insulin resistance, bone health, and fracture risk.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Review
- Bone metabolism in diabetes: a clinician's guide to understanding the bone-glucose interplay.Diabetologia · 2024Review
- Dietary glycemic and insulin indices with the risk of osteoporosis: results from the Iranian teachers cohort study.Frontiers in nutrition · 2024Article
- Causal relationship between type 2 diabetes mellitus and bone mineral density: a Mendelian randomization study in an East Asian population.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Determinants of Bone Mineral Density in Iranian Women with Polycystic Ovary Syndrome.International journal of endocrinology and metabolism · 2023Article
- Association between the triglyceride-glucose index and calcified aortic stenosis in elderly patients: a cross-sectional study.Scientific reports · 2023Article
- Associations of Type 2 Diabetes, Body Composition, and Insulin Resistance with Bone Parameters: The Dubbo Osteoporosis Epidemiology Study.JBMR plus · 2023Article
- Association between clinical use of nifedipine and the risk of osteoporosis: a nationwide retrospective cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
8 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
Although several studies have noted increased fracture risk in individuals with type 2 diabetes mellitus (T2DM), the pathophysiologic mechanisms underlying this association are not known. We hypothesize that insulin resistance (the key pathology in T2DM) negatively influences bone remodeling and leads to reduced bone strength. Data for this study came from 717 participants in the Biomarker Project of the Midlife in the United States Study (MIDUS II). The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated from fasting morning blood glucose and insulin levels. Projected 2D (areal) bone mineral density (BMD) was measured in the lumbar spine and left hip using dual-energy X-ray absorptiometry (DXA). Femoral neck axis length and width were measured from the hip DXA scans, and combined with BMD and body weight and height to create composite indices of femoral neck strength relative to load in three different failure modes: compression, bending, and impact. We used multiple linear regressions to examine the relationship between HOMA-IR and bone strength, adjusted for age, gender, race/ethnicity, menopausal transition stage (in women), and study site. Greater HOMA-IR was associated with lower values of all three composite indices of femoral neck strength relative to load, but was not associated with BMD in the femoral neck. Every doubling of HOMA-IR was associated with a 0.34 to 0.40 SD decrement in the strength indices (p<0.001). On their own, higher levels of fasting insulin (but not of glucose) were independently associated with lower bone strength. Our study confirms that greater insulin resistance is related to lower femoral neck strength relative to load. Further, we note that hyperinsulinemia, rather than hyperglycemia, underlies this relationship. Although cross-sectional associations do not prove causality, our findings do suggest that insulin resistance and in particular, hyperinsulinemia, may negatively affect bone strength relative to load.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.