An Evaluation of Bone Density and Turnover in Premenopausal Women with Type 1 Diabetes Mellitus

Abstract

Measurement of bone density and turnover was assessed in 20 premenopausal females with Type 1 diabetes mellitus and 27 age-sex-matched controls. Measurement was made of spinal (L2-4) and neck of femur bone density by dual-energy X-ray absorptiometry. L2-4 density was significantly higher in the diabetic patients compared with controls (1.224 +/- 0.021 g cm-2 vs. 1.161 +/- 0.020 g cm-2: p = 0.016). No significant difference was noted between the groups in neck of femur density. Measurement of bone formation was assessed by serum alkaline phosphatase and bone resorption by fasting urinary hydroxyproline/creatinine ratio. Alkaline phosphatase was significantly higher in the diabetic patients (185 +/- 16 Ul-1 vs 135 +/- 10 Ul-1: p < 0.01) as was hydroxyproline/creatinine ratio (0.028 +/- 0.003 vs 0.017 +/- 0.002: p = 0.002). No significant correlation was found between L2-4 density and glycated haemoglobin, duration of diabetes or daily dose of insulin taken. These data suggest that osteopenia is not associated with Type 1 diabetes mellitus; however these patients do have evidence of increased bone turnover and may therefore be at risk of osteoporosis in later life, particularly after the menopause.

Bone mineral density and hip structural analysis in type 1 diabetic men

“…In majority of earlier studies performed on type 1 diabetic population, both lumbar spine and hip BMD was decreased moderately. However, some studies reported normal hip BMD (22,23), and normal (24) or even increased spine BMD (25). Nevertheless, there is agreement that approximately 40-50% diabetic patients have decreased BMD and this decrease is independent of age, diabetes duration, presence of chronic microvascular complications, and the onset of diabetes (5,6,26), similar to our results.…”

Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus

“…Areal bone mineral density (aBMD) in young individuals with type I diabetes appear to be decreased in most (1)(2)(3)(4), but not all studies (5,6). In older patients with type I diabetes or insulin dependent diabetes a decreased bone density has been reported (7)(8)(9).…”

“…Reports concerning women with type II diabetes or non-insulin dependent diabetes have shown higher aBMD than controls without diabetes (10)(11)(12)(13)(14)(15), however not always significant (8,16) Bone turnover has been extensively studied in diabetic disease. In pre-menopausal diabetic women the disease is accompanied by a high bone turnover (1,3,5). In elderly women with type II diabetes or non-insulin dependent diabetes mellitus it has been reported that bone turnover is decreased (11,(17)(18)(19)(20), unchanged (16) or with a more mixed finding compared to in controls (13).…”

Middle-Aged Premenopausal Women With Type 1 Diabetes Have Lower Bone Mineral Density and Calcaneal Quantitative Ultrasound Than Nondiabetic Women

“…The Nord-Trodelag Health Survey (1) and the Iowa Women's Health Survey (2) found a 7-and 12-fold increase in hip fractures, respectively, in older type 1 diabetic women. Type 1 diabetes was associated with ϳ10% lower bone mineral density (BMD) compared with nondiabetic adults (3-10) in most but not all studies (11)(12)(13), though many include only small numbers of cases and lack adjustment for traditional osteoporosis risk factors (e.g., lower body weight and smoking). Few investigations (3,5,13) of type 1 diabetes and BMD focus exclusively on middleaged and postmenopausal women, those at highest risk for osteoporosis and fractures.…”