Association between bone mineral density and type 1 diabetes mellitus: a meta‐analysis of cross‐sectional studies

Abstract

A few studies have investigated the relationship between type 1 diabetes mellitus (T1DM) and bone mineral density (BMD) values. This meta-analysis was performed to explore differences between T1DM and healthy individuals in BMD values measured at five bone sites.We searched the database of PubMed for cross-sectional studies about the association of T1DM and BMD, and a meta-analysis was conducted.The results suggested significant association between T1DM and decreased BMD values of total body. The pooled mean differences (MDs) were -0.06 [95% confidence interval (CI): -0.11, -0.01] for all people. As for the association between T1DM and spine BMD values, the pooled MDs were -0.04 (95% CI: -0.07, -0.01) for males and -0.03 (95% CI: -0.06, 0.00) for females <20 years old. As for femur BMD values, the pooled MDs were -0.06 (95% CI: -0.13, 0.00) for all people, -0.03 (95% CI: -0.06, -0.01) for females and -0.04(95% CI: -0.05, -0.02) for males. As for hip BMD values, the pooled MDs were -0.06 (95% CI: -0.08, -0.04) for females. As for forearm BMD values, the pooled MDs were -0.01 (95% CI: -0.02, 0.00) for females.The results of this meta-analysis suggest the overall association between T1DM and reduced BMD values. Notably, the influence of T1DM on BMD seems to depend on gender or patient's age. Reduced BMD values may occur early after T1DM diagnosis. Future clinical and basic research studies are needed to further understand the mechanisms of decreased BMD values in T1DM patients.

Relationship between glycemic control and OPG gene polymorphisms with lower bone mineral density in patients with type 1 Diabetes mellitus

“…In agreement with our results, Gunczler et al, (1998) suggested that T1DM in children was associated with low bone turnover resulting in a decline in bone mass, which might manifest as osteopenia in the growing bone (Gunczler et al, 1998). Pan et al (2014), in a metaanalysis of cross-sectional studies, reports that T1DM is associated with a significantly lower BMD overall, and BMD (including total body, spine and femur) differences were also observed in patients <20 years old. However, bone loss among patients with T1DM <20 years old suggested that BMD may decrease relatively early in the course of the disease (Pan et al, 2014).…”

“…Pan et al (2014), in a metaanalysis of cross-sectional studies, reports that T1DM is associated with a significantly lower BMD overall, and BMD (including total body, spine and femur) differences were also observed in patients <20 years old. However, bone loss among patients with T1DM <20 years old suggested that BMD may decrease relatively early in the course of the disease (Pan et al, 2014). Notably, osteopenia has been reported at the onset of T1DM, suggesting the existence of pathogenic mechanisms that operate before the overt manifestation of T1DM.…”

“…It is established that islet cell destruction and insulinopenia begin several years before the onset and clinical recognition of disease. Therefore, it is possible that some of the autoimmune and auto-inflammatory responses, occurring before and after the onset of diabetes, may play a role in bone loss (Pan et al, 2014).…”

“…However, the association between T1DM and bone mineral density (BMD) is controversial. Some studies have demonstrated a reduced BMD (Pan et al, 2014;Kujath et al, 2015), while others have shown normal or even increased BMD (Gallacher et al, 1993;Maggio et al, 2010) in patients with T1DM compared to control subjects.…”

Status of Bone Mineral Density in Children with Type 1 Diabetes Mellitus and Its Related Factors

“…Considering importance of osteoporosis in the individual's activity and increased risk of pathological fractures in the future, determining prevalence and risk factors of the problem in children with type 1 DM and necessary treatments for its reduction is essential (13). Previous studies showed that type 1 DM causes reduction of bone density and ossification markers and increasing bone loss markers, and BMD is a good indicator for detecting changes in bone quality (14)(15)(16)(17)(18)(19)(20).…”