diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion , 
 insulin action , or both . a consequence of this is chronic hyperglycemia with disturbances in 
 carbohydrate , fat , and protein metabolism . diabetes mellitus ( dm ) is a common disorder of 
 carbohydrate , fat , and protein metabolism reflected by inappropriate high fasting and 
 postprandial glucose levels ( hyperglycemia ) . this ailment results from the absence or 
 scantiness of insulin secretion with or without concurrent impairment of insulin action . consequently , the disease was classified into two types known as type  i  ( insulin dependent , 
 iddm ) and ii ( non - insulin dependent , niddm ) according to the degree of pancreatic defect . this classification has been even recognized since the time of ibn sinaa , who mentioned it 
 in his book  the canon of medicine  . dm is not confined to abnormal blood glucose levels but progresses to affect other body 
 systems . this fact has been confirmed by several epidemiological studies and clinical trials 
 that have linked hyperglycemia to several complications at the macrovascular ( coronary 
 artery disease and cerebrovascular disease ) and microvascular levels ( renal failure , 
 blindness , limb amputation , neurological complications and premature death)1 . endocrine and metabolic alterations in diabetes mellitus can trigger disorders of calcium 
 homeostasis , skeletal metabolism , and bone mass1 . it is reported that more than of 50% type 1 diabetes patients have 
 osteoporosis ( op ) , which is called diabetic osteoporosis ( do ) , a reduced bone mass and an 
 increased fracture risk shown to occur in type 1 diabetes mellitus2 . on the other hand , in type 2 diabetes , several but not all 
 cross - sectional studies have found normal3 
 or elevated4 bone mass , and these results 
 are surprising given the increased fracture risk associated with type 2 diabetes5 . in type 2 dm patients complicated with op , 
 there is a larger decrease in bone formation than bone resorption in compared with the case 
 of postmenopausol op , and this mainly influences the indexes of bone formation and may be a 
 lower turnover ratio type . we investigated whether there is any difference among dm patients and a control group in 
 terms of lumbar and femur bmd ( bone mineral density ) and standard deviation scores ( z score 
 and t score ) . this randomized , prospective , controlled , single - blind study was conducted in physical 
 medicine and rehabilitation department faculty of medicine , bezm - i alem vakf university . in addition to their demographic 
 characteristics ( age , gender , weight , height , body mass index [ bmi ] ) , waist circumference , 
 hip circumference , waist / hip proportion , used medicines , body muscle masses , fat masses , and 
 fat percentages were obtained . the patients included in this study were between the ages of 
 40 and 65 . all the recruited subjects signed informed consent forms before participating in the study , 
 and approval of a local ethics committee was obtained . the exclusion characteristics were 
 early menopause , hormone replacement therapy , usage of medicines able to affect bmd 
 ( thiazide diuretics , statins , anticoagulants , antiepileptics ) , diseases affecting bone 
 metabolism ( hypo / hyperthyroid , cushing syndrome , primary hiperparathyroidism , renal failure , 
 liver disease , inflammatory bowel disease , malabsorption ) , alcoholism , osteoporotic breakage 
 history , scoliosis . data about 
 the presence of diabetic complications ( retinopathy , ischemic cardiac disease , hypertension , 
 neuropathy , nephropathy ) were regularly recorded in during follow - up . the whole blood count , 
 fasting blood glucose , urea , creatine , c - reactive protein , hba1c ( glycolysed hemoglobin ) , 
 alkaline phosphatase ( alp ) , calcium ( ca ) , phosphor ( p ) levels , and erythrocyte sedimentation 
 rate ( esr ) were examined , and a 24-h urinalysis was carried out . through dual - energy x - ray absorptiometry ( dexa , dpx - lunar ) , bmd measurements of the lumbar 
 spine ( anteroposterior projection of l1-l4 ) and left proximal femur ( total score ) were 
 executed . the bmd data are presented in g / cm and standard deviation scores ( z 
 and t scores ) . t scores between 1 and 2.5 were considered to indicate osteopenia , and 
 those equal or below 2.5 were considered to indicate osteoporosis ( who study group , 
 1994 ) . the calculations were performed using the statistical package for social sciences for 
 windows software version 16.0 ( spss inc . , the kolmogorov - smirnov test was 
 used to confirm that data within the ranges of the normal distribution in both groups . the 
 comparison of the data between the groups was carried out with the mann - whitney u - test . the 
 wilcoxon signed - rank test was used to examine the pre- and post- exercise differences within 
 groups . statistical significance was based on a value of p < 0.05 with a 95% confidence 
 interval . a total of 126 patients completed the study ( 63 in the study group , 63 in the control 
 group ) . the clinical and demographic characteristics of the patients and the healthy 
 controls are listed in table 1table 1.clinical and demographic characteristics of patient and control groups ( mean  sd 
 or n , % ) dm group(n=63)control group(n=63)age60.18.558.47.8male patients ( n , % ) 29 ( 46%)30 ( 47%)bmi ( cm / kg)32.44.828.45.5 dm : diabetes mellitus ; sd : standard deviation . there was no significant difference in the result of the laboratory 
 examinations of the cases ( table 2table 2.clinical and demographic characteristics of patient and control groups ( mean  sd 
 or n , % ) dm group(n=63)control group(n=63)ca ( mg / dl)8.80.28.50.2p ( mg / dl)4.20.84.30.8alp ( u / l)85.9 + 26.784.4 + 32.3fasting blood glucose ( mg / dl)162.444.898.415.524-h urea ca143.881.1133.855.4urea ( mg / dl)4811.2428.2creatine ( mg / dl)0.90.30.70.2esr15.68.218.17.5crp0.20.40.10.5 dm : diabetes mellitus ; sd : standard deviation . p < 0.05 is significant ) . the bone mineral densities of the cases are presented in table 3table 3.bmd , z and t scores of patient and control groups ( mean  sd or n , % ) dm group(n=63)control group(n=63)plumbar ( l14 ) bmd46.6205.41.10.1lumbar ( l14 ) t score0.91.10.011.7lumbar ( l14 ) z score0.011.10.11.2total femur bmd14.9110.61.00.1total femur t score0.21.00.01.2total femur z score0.50.90.11.3 dm : diabetes mellitus ; sd : standard deviation . p < 0.05 is 
 significant .. regarding the medications taken by the diabetic patients , 48 patients were 
 using oral antidiabetic , and 8 patients were using insulin , and 7 patients were using both 
 of them . with regard to the disease durations , there were 23 patients in the 05 year group 
 ( 36.5% ) , 17 patients in the 610 year group ( 27% ) , 14 patients in the 1115 year group 
 ( 22.2% ) , 4 patients in the 1620 year group ( 6.3% ) , 1 patient in the 2125 year group 
 ( 1.6% ) , and 4 patients in the 2630 year group ( 6.3% ) . no significant correlation was 
 detected when comparing disease durations and the bone marrow densities of the type 2 dm 
 patients by the medicines taken ( p>0.050 ) ( table 
 4table 4.bmd , z and t scores of drug usages of diabetic patients ( mean  sd or n , 
 % ) oral antidiabetic(n=48)insulin(n=15)lumbar ( l14 ) bmd53.6195.442.3180.1lumbar ( l14 ) t score0.61.10.81.7lumbar ( l14 ) z score0.041.00.01.3total femur bmd14.9110.613.0100.1total femur t score0.21.10.11.2total femur z score0.50.90.51.2 dm : diabetes mellitus ; sd : standard deviation . the most important aim of our study was to compare the bone mineral densities of type 2 
 diabetes mellitus patients with those of a normal , healthy population . in our examinations , 
 we determined that there was a significant decrease in the lumbar region t score in compared 
 with the normal population . although osteoporosis is one of the complications of type 1 diabetes , the effect of type 2 
 dm on bone mineral density is controversial . in different studies , the bmd values in type 2 
 dm have increased6 , decreased7 , or stayed normal8 . in general , the type 2 dm patients with low bmd values have 
 been observed to have long - term diabetes and menopause , to have poor glucose control , and to 
 have disordered renal functions9 . furthermore , in some studies , it has been concluded that diabetic women are protected from 
 osteopenia10 . this can be explained in 
 type 2 dm , unlike the case of type 1 dm , by the frequent observation of obesity due to 
 increased insulin resistance and the higher of osteoarthritis in dm patients11 . in the study of sosa et al . , 47 female type 2 dm patients and 252 nondiabetic women were 
 compared in terms of bmd through dexa and quantitative computerized tomography , and no 
 significant difference was detected12 . in 
 the literature , it has been found that type 2 dm patients , individuals using a dietary and 
 oral antidiabetic , and individuals taking insulin have lower bmd values13 . it has been asserted that better glysemic control , 
 exercise , diet , and medical therapy can decrease the complications in dm14 . but in our study , no difference could be 
 determined in bmd in relation to medicine usage . in measurements from the calcaneal region , a previous study reported higher bmd values in 
 postmenapousal women and similar values to those of a control group in diabetic men , and it 
 has been determined that there was no difference between women and men15 . one of them is 
 that it can lead to diabetic osteopenia due to deficiency in anabolic activation of 
 insulin13 . another mechanism asserted 
 in diabetic osteopenia is suppression of osteoblastic bone formation16 . in previous studies , it has been shown that decreases in 
 osteoblastic functions occurred in diabetic ostopenia17 . previous studies have also shown that the bone cycle speed in type 
 2 dm is much slower than that in healthy postmenopausal patients18 . in another study on type 1 and type 2 diabetes patients , 
 it has been underlined that the decrease in bone mass can be related with decrease in bone 
 formation and microangiopathy in bone tissue19 . in histopathologic examination of type 2 dm patients , the 
 osteoblast surface , cortical thickness , osteoid thickness , osteoid volume , and bone volume 
 have been found to be lower in diabetic patients . it has been concluded that the mechanism 
 laying behind the diabetic osteopenia can be the decrease of quantitative osteoid , the 
 decrease of osteoblasts , and finally the decrease of bone cycle17 . in dm patients , estradiol has a direct stimulatory effect on 
 osteoblasts , and this may contribute to osteoporosis20 . as a result , the bmd measurements the postmenopausal women with type 2 diabetes mellitus in 
 the present study did not show any difference in proportion to those of the control 
 group .