1. of many conditions, if it is used

1.     
The incidence of diabetes
mellitus is increasing in an alarming rate worldwide. Irrespective of
socioeconomic status, similar trend has also been observed in India including
Uttarakhand where prevalence of diabetes from 1.2% in an ICMR survey (2008) has
gone up to 5.7% in NPCDCS survey (2012)1

2.     
Diabetes mellitus has been recognized as a risk factor for osteoporosis
and fragility fracture where the underlying mechanism is yet to be defined.

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3.     
Although, WHO has defined osteoporosis with respect to Bone Mineral
Density (BMD),the poor sensitivity of BMD may miss the diagnosis of many
conditions, if it is used alone.—This could be overcome by the measurement of
bone turn over markers.2

4.     
Sclerostin is an osteocyte
marker and prevents osteoblast differentiation as well as bone formation
through inhibition of WNT signaling pathway. 2

5.      Hamann et al (2013) demonstrated
that Sclerostin antibody treatment could improve the skeletal deficits of
diabetic ZDF rats3 Therefore, the serum Sclerostin level measurement could be
useful in DM individuals.

6.     
A few studies have been
conducted to measure the circulating Sclerostin level in individuals with type
1 4 and type 2 5 diabetes mellitus. All T2D individuals have to go through
prediabetes stage. Hence Sclerostin level measurement in Prediabetic
individuals may help in early initiation of prophylactic interventions.—this
study would attempt to bridge that gap of knowledge.

7.      Costa et al (2013) documented that
bone turn over markers were differentially associated with Sclerostin by race
6. Hence it is important to measure the circulating
Sclerostin level even in Indian population, since no such study was conducted
in India.

8.     
One study 5 has shown a
negative association between Sclerostin and PTH level while the other study 4
has shown the opposite trend. —This study is to resolve that issue.

9.      Almario and Karakas (2015) showed
that WNT signaling plays an important role in insulin resistance / secretion,
inflammations and cardiovascular risk.Moreover, bone turnover may fluctuate
depending on the glucose level. Hence, better understanding of therole of WNT
signaling in prediabetic individual is essential for delaying the onset of
diabetes and reducing the severity of bone related complications in patients
with diabetes.

10.  Knowledge in Sclerostin (WNT
signaling inhibitor) may give an insight into the molecular mechanism related
to WNT signaling pathway involved in the development of DM and its
complications.

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