Association between low C-peptide and low lumbar bone mineral density in postmenopausal women without diabetes

T. Montalcini, P. Gallotti, A. Coppola, V. Zambianchi, M. Fodaro, E. Galliera, M. G. Marazzi, S. Romeo, S. Giannini, M. M. Corsi Romanelli, A. Pujia, C. Gazzaruso

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Summary: In this population-based, cross-sectional study in Italian postmenopausal females not affected by diabetes, we showed a link between serum C-peptide and lumbar bone mineral density, suggesting that C-peptide exerts an insulin-independent effect on bone mass.Introduction: It is well known that type 1 (T1) diabetes, characterized by insulin and C-peptide deficiency, is associated with a low lumbar bone mineral density and an increased risk for fracture. While a role for insulin in the pathogenesis of osteoporosis has been demonstrated, the association between C-peptide and the bone mineral density has not been investigated. We conducted a study in a cohort of 84 postmenopausal women without diabetes to clarify the association between serum C-peptide and the lumbar bone mineral density.Methods: Participants underwent a bone mineral density evaluation by DXA and biochemical analysis including the C-peptide assay.Results: rteen percent of the population had osteoporosis and 38 % had osteopenia. With ANOVA test, we showed that women with the lowest C-peptide concentration had lower lumbar mineral density in comparison to those in all other C-peptide concentration group (p = 0.02 among groups after adjustment). The univariate and multivariate analysis showed that C-peptide was positively associated with both lumbar T-score and Z-score besides other well-known factors like age (with T-score p <0.001; beta = −0.38) and BMI (with T-score p = 0.009; beta = 0.34), while insulin was not correlated with the lumbar bone mineral density. The area under the receiver operating characteristic (ROC) curve for C-peptide to predict the absence of lumbar osteoporosis was 0.74 (SE = 0.073; p = 0.013).Conclusions: These results suggest that C-peptide may exert an insulin- and BMI-independent effect on lumbar bone mineral density and that further large-scale studies are needed in order to clarify its role in bone mineralization especially in subjects without diabetes.

Original languageEnglish
Pages (from-to)1639-1646
Number of pages8
JournalOsteoporosis International
Issue number5
Publication statusPublished - May 1 2015


  • C-peptide
  • Lumbar bone mineral density
  • Menopause
  • Survey

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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