Epidemiology of Skeletal Health in Type 1 Diabetes

Abstract

The skeleton is adversely affected by type 1 diabetes (T1D). Patients with T1D of both sexes have an increased risk of fracture that begins in childhood and extends across the entire lifespan. T1D is characterized by mild to modest deficits in bone density, structure, and microarchitecture. Current evidence suggests that the observed bone deficits in T1D are the result of impaired bone formation rather than increased bone resorption. There is emerging data that bone quality is impaired in T1D, which may explain the findings that fracture risk is elevated out of proportion to the degree of bone mineral deficit. In this review, we summarize the current knowledge regarding the epidemiology of skeletal health in T1D. Given the high individual and societal burden of osteoporotic fracture, there is an urgent need to better understand the etiology of T1D-related bone disease so that clinical strategies to prevent fracture can be developed.

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“…Individuals with T1D suffer from increased morbidity and mortality (1) and are at greater risk for other complications such as chronic kidney disease, cardiovascular disease, infections, and osteoporosis (2–4). An estimated 1.3 million adults and children in the US have T1D, and prevalence is expected to exceed 5 million by 2050 (5,6).…”

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“…An assessment of the impact of chronic SGLT2 inhibition on bone health and amputation risk in T1D is especially pertinent as these patients are at high risk of osteoporosis, fractures, neuropathy, peripheral vascular disease, and amputations. 28,29 Most importantly, there has been growing concern about the increased risk of ketoacidosis associated with the use of SGLT2 inhibitors. In animal studies, phlorizin induced hyperketonemia in rats and decreased the renal clearance of acetoacetate in dogs.…”