Lower BMD observed in adults with long-standing type 1 diabetes
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Adults with type 1 diabetes for at least 25 years have lower areal bone mineral density compared with those without diabetes, and diabetic neuropathy is linked to further BMD declines in the ultradistal tibia, according to study data.
“This is the first study to assess bone mineral density, bone microarchitecture, biochemical and estimated biomechanical bone parameters in patients with long-standing, well-controlled type 1 diabetes,” Christian Meier, MD, associate professor of endocrinology at the University of Basel in Switzerland, and colleagues wrote in a study published in the Journal of Bone and Mineral Research. “Compared to nondiabetic controls, we observed a reduced areal BMD at all measured sites, low [C-terminal telopeptide of type 1 collagen], a marker of bone resorption, and a cortical bone deficit at the ultradistal tibia with impaired bone strength and bone stiffness as modeled by hemochromatosis gene analysis.”
Researchers conducted a cross-sectional, case-controlled study at the endocrine clinic of University Hospital Basel in Switzerland. Researchers recruited 59 adults with a type 1 diabetes duration of at least 25 years with or without microvascular disease. The group was compared with a control cohort of 77 adults without diabetes. Fasting blood samples were collected for each participant, and the presence of microvascular and macrovascular disease were obtained from medical records. Participants underwent a DXA scan to measure areal BMD at the lumbar spine, hip and distal radius. High-resolution peripheral quantitative CT was performed at the ultradistal radius and tibia in 51 adults in the diabetes group and 64 controls.
Of those with diabetes, 64.4% had evidence of microangiopathy, 44.1% had diabetic retinopathy, 16.9% had diabetic nephropathy defined as evidence of microalbuminuria and 37.2% were diagnosed with diabetic peripheral neuropathy.
Adults with type 1 diabetes had lower areal BMD at the total hip (P < .001), lumbar spine (P = .04), femoral neck (P = .05) and distal radius (P = .01) compared with controls. Fracture Risk Assessment Tool (FRAX) scores for hip (P < .01) and major osteoporotic fractures (P = .02) were higher for those with diabetes compared with controls.
Of adults who had a high-resolution peripheral quantitative CT performed, those with diabetes had lower cortical thickness (P < .01), cortical volumetric BMD (P = .03), bone strength (P < .01) and bone stiffness (P < .01) at the ultradistal tibia compared with controls. Participants with diabetes and diabetic neuropathy had lower cortical volumetric BMD compared with those with diabetes who did not have diabetic neuropathy. The presence of diabetic neuropathy was associated with lower bone strength (P = .02) and bone stiffness (P = .01) compared with those with diabetes and no neuropathy. Adults with diabetes and diabetic neuropathy also had lower bone stiffness and bone strength compared with the control group (P < .001 for both).
“Both the impaired cortical parameters and the altered estimated biomechanical properties at the tibia are dependent on the presence of diabetic neuropathy,” the researchers wrote. “Further research is warranted to evaluate whether these structural changes and specifically the presence of diabetic neuropathy can explain the increased fracture risk in type 1 diabetes.”
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