Glycaemic control is positively associated with prevalent fractures but not with bone mineral density in patients with Type 1 diabetes

Abstract

Type 1 diabetes contributes to low bone mineral density in women. Previous fractures and low BMI were strong predictors of impaired bone mineral density and should therefore be considered in risk estimation. Fractures are more frequent in Type 1 diabetes. Long-term hyperglycaemia may account for impaired bone strength, independently from bone mineral density.

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

“…Although the decreased BMD reported in subjects with T1DM (27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,50,58) may largely explain the higher fracture risk observed in these patients (17,18,19,20,21,22,26), alterations in bone quality, as described below, may also contribute and actually confer its specific nature to diabetic bone disease.…”

“…Other studies (19) failed to document any association with duration, whereas yet others (22) proposed a bimodal relationship with the highest incidence occurring within the first 2.5 years and again beyond 5 years of diabetes being diagnosed. Most, but not all (26), studies failed to document a relationship between the risk of fracture and glycemic control. An association between the presence of microvascular complications of diabetes and the increase in fracture risk was, however, reported in most studies (17,18,19,20,21,22).…”

Trabecular bone score in type 1 diabetes—a cross-sectional study

“…The cross-sectional study was designed to calculate the TBS by means of 2D gray-scale DXA images of the lumbar spine obtained from a large cohort of male and female patients with long-standing T1D and controls [14]. Associations of various parameters, including individual patient characteristics, BMD and TBS, with prevalent fractures were also investigated.…”

“…This cohort was initially recruited to investigate the association between glycemic control, BMD, and risk of fractures in T1D [14]. Exclusion criteria were a disease duration <3 years, co-medication with corticosteroids, menopause or no menstrual period within the last 12 months, pregnancy, chronic inflammatory disease, malnutrition, renal failure [glomerular filtration rate (modification of diet in renal disease formula) <30 ml/min], and severe mental or somatic disease.…”

“…The present cross-sectional study was initially conducted and powered to investigate differences in BMD between patients with T1D and controls [14]. We now re-investigated the initial cohort, and focused on the indirect evaluation of the lumbar spine trabecular microarchitecture by means of TBS measurements obtained from conventional DXA.…”