الفهرس 
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Abstract
Several studies have implicated that bone turn over markers (BTMs) are more sensitive than BMD in estimating fracture risk in patients with diabetes owing to linkage between BTMs and glucose metabolism (Clemens TL, Karsenty G. 2011).
However, few studies addressed the association between BTMs and diabetic complications. We hypothesize that circulating levels of BTMs can be helpful for management of osteoporosis and prevention of bone fracture in presence of diabetes complications.
Bone sialoprotein is a new marker for bone resorption, in our study we are trying to find possible relation between sialoprotein activity and diabetes microvascular complication.
A total of 60 type 2 diabetes patients (30 patients with diabetic micro-vascular complications (retinopathy and/or nephropathy) as a case group and 30 patients without retinopathy and/or nephropathy) as a case group and 30 healthy individuals serve as control group was recruited in this case–control study from diabetes and endocrinology clinic and internal medicine department in Beni Suef university hospital. The biochemical and metabolic parameters and bone turnover marker will be assessed in all patients.
Informed consent was taken from all paticipents: -
Inclusion criteria:-
1. The diagnosis of type 2 diabetes carried out and/ or confirmed following the American Diabetes Association criteria (ADA ., 2002) .
2. The diagnosis of retinopathy carried out according to the American Academy of Ophthalmology recommendations (Schubert HD, Regillo CD ., 2013) .
3. According to previously described definitions, a urine albumin-to-creatinine ratio was determined from a random urine collection of all patients and classified as normal (urine microalbumin: creatinine ratio ≤ 30 μg/mg), micro albuminuria (urine microalbumin: creatinine ratio >30 μg/mg and ≤ 299 μg/mg) and macro albuminuria (urine microalbumin: creatinine ratio ≥ 300 μg/mg) at least on two separate occasions (ADA ., 2002) .
Exclusion criteria: -
1. Cancer patients.
2. Extreme age.
3. Chronic disorders.
4. Steroid treatment.
Data collection and measurements: Demographic and clinical characteristics including: -
1. Sex.
2. Age .
3. Diabetes duration .
4. Age of onset of diabetes (years) .
5. Cigarette smoking status .
6. Current use of medications .
7. Height and weight were measured using standard anthropometric techniques. Body mass index was calculated as body weight (kg)/(height (m2 ) .
8. Blood pressure was measured twice after a 10 min seated rest .
9. FRAX score to asses fracture risk probability .
Blood samples will be collected after an overnight fasting. The sera will be kept at −80 °C until analysis and the samples will be analyzed for the following:-
1. Fasting glucose .
2. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) .
3. Blood urea nitrogen (BUN), and creatinine .
4. Urine microalbumin and creatinine levels .
5. Glycated hemoglobin (HbA1c) .
6. Serum bone sialoprotien as marker for bone turn over .
This kit is used to assay the Bone sialoprotein(BSP)in the sample of Human’s serum, blood plasma and other related biological liquid.
Results:
• Our results showed that there is statistically significant low mean height with p-value <0.05 among diabetic patients with microvascular complications.
• Our results showed that that there is statistically significant low mean serum calcium, and e-GFR level also high mean of HBA1C%, triglyceride, AST, creatinine, and albumin/creatinine ratio among diabetic patients with microvascular complications with p-value <0.05. On the other hand there is no statistical significance difference between study groups with p-value >0.05 as regards other investigations (cholesterol, and ALT level).
• Our results showed that there is statistically significant e high mean of bone sialoprotien level among diabetic patients with microvascular complications with p-value <0.05, and lower mean was noticed among diabetic patients without microvascular complications.
• Our results showed that there is statistically significant positive correlation with p-value <0.05 between bone sialoprotien and T-score AP but there is no statistically significant correlation with p-value >0.05 with FRAX% and other T-Scores among patients with microvascular complications, which indicated increase in bone sialoprotien will associated with increase in T-score AP.Also there is no statistically significant correlation between bone sialoprotien and other bone markers with p-value >0.05 among patients without microvascular complications.
So, we conclude that bone sialoprotein is a good bone resorption biomarker in diabetic patients with microvascular complication and it is related to osteoporosis severity in diabetics.
BSP can also be added to panel of diagnosis of diabetic bone disease