Evaluation of Receptor Activator of Nuclear Factor Kappa-B Ligand and Osteoprotegerin Levels in Patients with Type 2 Diabetes Mellitus Treated with Oral Anti-diabetics (Sulfonylurea and Metformin) or Insulin: Bone Tissue Perspective

Introduction: We aimed to investigate the levels of receptor activator of nuclear factor kappa-b ligand (RANKL) and osteoprotegerin (OPG) in order to evaluate the negative effects of type 2 diabetes mellitus on bone health and their relationship to the severity of disease based on the treatment. We also evaluated the relationship between hemoglobin A1c (HbA1c), parathyroid hormone (PTH) and bone specific alkaline phosphatase (BAP) levels and RANKL and OPG levels. Methods: The study group consisted of 19 volunteers (15 females and 4 males) and 65 patients with type 2 diabetes mellitus (49 females and 16 males). In order to evaluate the relationship between the treatment and the disease severity, the patient group was divided into two subgroups: patients treated with oral anti-diabetics (OAD) (sulfonylurea and metformin) or insulin. The levels of glucose, calcium, phosphorus, HbA1c, BAP, PTH, RANKL and OPG were compared. Results: The RANKL and OPG levels of patients treated with insulin were significantly higher than the control group (p=0.008, p=0.033, respectively). However, there was no significant difference in the OAD group for both parameters (p=0.1, p=0.46, respectively). There was no significant difference between the groups in terms of PTH and BAP levels (p=0.97, p=0.66, respectively). Conclusion: We believe that RANKL and OPG levels are higher in patients with poor glycemic control and that they may be indicators of disease severity.