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

• Published in: Diabetic medicine Vol. 28; no. 7; pp. 872 - 875
• Main Authors: Neumann, T., Sämann, A., Lodes, S., Kästner, B., Franke, S., Kiehntopf, M., Hemmelmann, C., Lehmann, T., Müller, U. A., Hein, G., Wolf, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Blackwell
• Subjects: Biological and medical sciences; Biomarkers - metabolism; Bone Density - drug effects; Bone Density - physiology; bone mineral density; Case-Control Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; fracture; Fractures, Bone - diagnostic imaging; Fractures, Bone - metabolism; Fractures, Bone - physiopathology; Fundamental and applied biological sciences. Psychology; Glycated Hemoglobin A - metabolism; HbA1c; Humans; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - metabolism; Lumbar Vertebrae - physiopathology; Male; Medical sciences; Middle Aged; Osteoporosis - chemically induced; Osteoporosis - metabolism; Osteoporosis - physiopathology; Prevalence; Radiography; Risk Factors; Type 1 diabetes; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Human; Immunopathology; Obesity; Prevalence; Nutrition; HbA; Diseases of the osteoarticular system; Nutrition disorder; Patient; Autoimmune disease; Metabolic diseases; Fracture; Hemoglobin A1; Trauma; Association; Surveillance; Type 1 diabetes; Hemoglobin A1c; Bone mineral density; Endocrinology; Nutritional status; Glycemia
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/j.1464-5491.2011.03286.x

Diabet. Med. 28, 872–875 (2011) Aim  There are conflicting data regarding the risk of osteoporosis in patients with Type 1 diabetes. We investigated an association between diabetes, bone mineral density and prevalent fractures. Methods  A single‐centre, cross‐sectional study of men and pre‐menopausal women with Type 1 diabetes (n = 128) and a matched control group (n = 77) was conducted. The primary outcome measure was bone mineral density and secondary measures were markers of bone metabolism and prevalent fractures. Results  Hip and total body bone mineral densities were significantly lower in women with diabetes compared with control subjects. In men, no difference in bone mineral density was found. A multivariate regression analysis in women with diabetes revealed higher BMI as the strongest predictor of higher total hip, femoral neck and total body bone mineral density, whereas previous fractures were inversely associated with total hip bone mineral density and C‐terminal telopeptide of type I collagen with total body bone mineral density. Poor long‐term glycaemic control was not associated with low bone mineral density. Fracture frequency was higher in patients with diabetes compared with control subjects (1.64 vs. 0.62 per 100 patient‐years; P < 0.05). In a multivariable model, long‐term HbA1c control was associated with increased clinical fracture prevalence (OR 1.92; 95% CI 1.09–2.75) in those with diabetes. Conclusions  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.