Different health behaviours and clinical factors associated with bone mineral density and bone turnover in premenopausal women with and without type 1 diabetes

Abstract

Background Women with type 1 diabetes (T1DM) have an elevated fracture risk. We therefore compared the associations of health behaviors and clinical factors with bone mineral density (BMD) and bone remodeling between premenopausal women with and without T1DM to inform potential interventions. Methods Participants included women with T1DM (n=89) from the Wisconsin Diabetes Registry Study and age- and race-matched controls without diabetes (n=76). Peripheral (heel, forearm) and central (hip, spine) BMD, markers of bone resorption and formation, bone cell signaling, glycemic control, and kidney function were assessed. Health behaviors and medical history were self-reported. Results In controls, but not in women with T1DM, older age was associated with lower bone resorption (p≤0.006) and formation (p=0.0007). Body mass index (BMI) was positively associated with heel and forearm BMD in both controls and T1DM women (all p<0.0001), but with hip and spine BMD only in controls (p≤0.005). Worse glycemic control during the previous 10 years, greater alcohol intake, history of smoking, and lack of physical activity were associated with poorer bone outcomes only in women with T1DM (all p≤0.002); whereas use of hormonal contraceptives was related to low bone formation in both women with and without T1DM (all p≤0.006). Diabetes duration, insulin dose, residual C-peptide, and kidney function were not associated with bone in T1DM. Conclusions Age and BMI may not predict bone health in T1DM women. However modifiable behaviors such as optimizing glycemic control, limiting substance and hormonal contraceptive use, and increasing physical activity may improve bone health in T1DM women.

Lower bone mineral density and higher bone resorption marker levels in premenopausal women with type 1 diabetes in Japan

“…Findings of lower heel BMD in premenopausal women with type 1 diabetes were consistent with the Wisconsin Diabetes Registry Study by Kujath et al 24 . and the study by Danielson KK et al 25 .…”

“…Findings of lower heel BMD in premenopausal women with type 1 diabetes were consistent with the Wisconsin Diabetes Registry Study by Kujath et al 24 and the study by Danielson KK et al 25 using DXA, and the study by Strotmeyer et al 26 using ultrasound. The reason for the lower BMD in type 1 diabetes patients in the premenopausal period remains unknown.…”

“…TRACP-5b is relatively new in development, so there are few reports of its use in type 1 diabetes patients 43 ; however, the results in two reports are comparable 24,43 . Serum TRACP-5b, BAP and OC are widely used in primary care settings in Japan 44 .…”

Osteoporosis: Modern Paradigms for Last Century’s Bones

“…However, body mass index (BMI) does not always correlate with bone health, particularly in diabetic women [ 32 ]. While bone turnover rate may be affected by body weight [ 33 ], body weight does not accurately predict fat mass or lean mass.…”

Relationship between glycemic control and OPG gene polymorphisms with lower bone mineral density in patients with type 1 Diabetes mellitus

“…However, the association between T1DM and bone mineral density (BMD) is controversial. Some studies have demonstrated a reduced BMD (Pan et al, 2014;Kujath et al, 2015), while others have shown normal or even increased BMD (Gallacher et al, 1993;Maggio et al, 2010) in patients with T1DM compared to control subjects.…”