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Fracture risk increases with type 1 diabetes, celiac disease
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Young adults with type 1 diabetes and celiac disease are more likely to sustain fractures than those who have type 1 diabetes alone, according to findings reported in Clinical Endocrinology.
Type 1 diabetes is associated with impaired bone quality and increased fracture rates, whereas celiac disease is also a recognized factor for secondary osteoporosis and fracture, leading researchers to speculate that the risk may be additive for patients with both conditions, Eleanor P. Thong, MBBS, FRACP, an endocrinology fellow at Monash Health in Clayton, Australia, and colleagues wrote in the study background.
In a retrospective, cross-sectional study, Thong and colleagues analyzed medical records from 346 patients with type 1 diabetes alone (median age, 23 years) and 49 patients with type 1 diabetes and celiac disease (median age, 24 years) attending specialist diabetes outpatient clinics between August 2016 and February 2017 at Monash Health. Patients with comorbid chronic kidney disease, glucocorticoid use, hypogonadism and untreated hyperthyroidism were excluded. Researchers assessed previous fractures (verified by radiologic reports and medical records), duration of type 1 diabetes, glycemic control, hypoglycemia incidence (assessed via glucose monitoring devices or logbooks), daily insulin dose, microvascular complications and celiac disease status.
Researchers documented 21 fractures in 18 patients in the cohort. Overall, a higher proportion of patients had fractures in the type 1 diabetes/celiac disease group vs. the type 1 diabetes only group (12.2% vs. 3.5%; P = .02). However, there was no difference in minimal trauma fractures between the two groups (33.3% vs. 25%). After adjusting for age, sex, BMI, vitamin D status, hypoglycemia, microvascular complications and HbA1c, researchers observed a relationship between celiac disease and fracture (OR = 3.5; 95% CI, 1.01-12.12).
Only three patients (6.1%) had a documented evaluation of bone mineral density within the past 5 years, according to researchers.
Patients with type 1 diabetes and celiac disease also had a higher prevalence of frequent hypoglycemia, defined as at least two episodes per week, compared with those who had type 1 diabetes alone (55.1% vs. 37.7%; P < .001). After adjustment for age, sex, duration of diabetes, HbA1c, BMI and total daily dose of insulin, the relationship between celiac disease and hypoglycemia remained significant (OR = 3.28; 95% CI, 1.61-6.69); however, the higher incidence of hypoglycemia was not independently associated with fractures, according to researchers.
“Clinicians should actively screen for and manage hypoglycemia in patients with concomitant type 1 diabetes and celiac disease, as hypoglycemia is a risk factor for falls, seizures and, ultimately, fractures,” Thong told Endocrine Today. “Prospective studies examining the long-term impacts of celiac disease on bone health and on glycemic control in type 1 diabetes are needed, particularly in older adults where the absolute risk of fracture is higher.” – by Regina Schaffer
For more information:
Eleanor P. Thong, MBBS, FRACP, can be reached at Monash Medical Center, 246 Clayton Road, Clayton, Victoria, Australia, 3168; email: eleanor.thong@monash.edu.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Young adults with concomitant type 1 diabetes and celiac disease have a more than 3-fold greater risk for fracture compared with those who have type 1 diabetes alone, according to a study from Melbourne. The data are from a cross sectional study of 49 adults with type 1 diabetes and celiac disease (fracture rate 12.2%) vs. 349 adults with type 1 diabetes alone (fracture rate 3.5%). Glycemic control, measured by HbA1c, did not differ between the groups, and the study groups were also well matched in terms of median age, sex, serum 25-hydroxyvitamin D levels, BMI and total daily dose of insulin. The relationship remained significant after adjustment for age, sex, BMI, vitamin D status, hypoglycemia, microvascular complications and HbA1c. Compared with those who had type 1 diabetes alone, those with type 1 diabetes and concomitant celiac disease had a higher adjusted risk for hypoglycemia (55% vs 38%; OR = 3.28; 95% CI, 1.61–6.69); however, those with type 1 diabetes and celiac disease also had a longer duration of type 1 diabetes vs. those with type 1 diabetes alone (mean of 14 years vs. 11 years). It is possible that the longer duration of diabetes may have impacted bone health; however, only three patients (6.1%) had documented evaluation of their bone mineral density within the last 5 years. The study highlights the lack of longitudinal data in adults with concomitant type 1 diabetes and celiac disease vs. type 1 diabetes alone, but suggests that monitoring bone health may be important.
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