Bone health in subjects with type 1 diabetes for more than 50 years

Abstract

Aims Few data regarding prevalence of and risk factors for poor bone health in aging individuals with long-standing T1D are available. In this study we aim to describe the prevalence of bone fragility and to identify factors associated with low bone density in individuals with long term T1D. Methods We examined the prevalence of non-vertebral fractures in 985 subjects enrolled in the Joslin 50-Year Medalist Study, and measured bone mineral density (BMD) by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine and radius in a subset (65 subjects, mean age 62.6 years, duration 52.5 years, HbA1c 7.1%) with no significant clinical or demographic differences from the rest of the cohort. Results Medalists have low prevalence of fractures (0.20% hip and 0.91% wrist) and normal Z-score values (spine +1.15, total hip +0.23, femoral neck −0.01, radius +0.26; p>0.05 for differences vs 0 at all sites). A significant relationship was found between lower BMD and higher total cholesterol, triglycerides and LDL levels, but not HbA1c. Low BMD at the femoral neck was associated with cardiovascular disease after adjustment for confounding factors: prevalence risk ratio (RR) [95% CI] of 4.6 [1.2–18.1], p=0.03 of CVD. No other diabetic vascular complication was found to be associated with low BMD. Conclusions These are the first data regarding bone health in aging individuals with T1D for more than 50 years. The low rates of non-vertebral fractures and the normal Z-score suggest the long T1D diabetes duration did not increase the risk of bone fractures in Medalists compared to non-diabetic peers. Additionally, the association with cardiovascular disease, demonstrates the BMD differences in group is likely not due to glycemic control alone.

ISPAD Clinical Practice Consensus Guidelines 2018: Other complications and associated conditions in children and adolescents with type 1 diabetes

“…Despite the higher risk of fracture, abnormal bone density as assessed by dual X‐ray absorptiometry (DXA) is not always consistently low in youth and adults with type 1 diabetes, with potential biases including pubertal status, diabetes duration, and differing methods to assess bone mineral density (BMD) . Identification of potential risk factors impacting fracture rates, that include aberrant metabolic control (HbA1c), dyslipidemia as well as the presence of other microvascular complications have been described in many, but not all reports …”

“…170,171 Identification of potential risk factors impacting fracture rates, that include aberrant metabolic control (HbA1c), dyslipidemia as well as the presence of other microvascular complications have been described in many, but not all reports. 169,172 Abnormal bone accrual (density and quality) in type 1 diabetes likely has a multifactorial etiology, involving reduced bone formation and abnormal bone quality. Two major determinants of bone strain in children are muscle action and growth.…”

New strategy to study the impact of ethnicity on diabetic neuropathy

“…South Asian immigrants in the United Kingdom represent a special cohort of patients showing protection from DN, which is highlighted by a well‐documented reduced risk of lower limb amputation . Searching for protective factors in clinical models of subjects showing protection from the progression of the disease has already led to significant results in diabetes . This is a smart approach for elucidating the pathophysiology of DN, unrevealing new protective factors and possibly providing new therapeutic targets.…”

Il metabolismo energetico dell’osteoblasta: implicazioni per l’osteoporosi

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Molteplici studi clinici hanno messo in evidenza importanti alterazioni scheletriche in corso di patologie che alterano l'apporto calorico e il metabolismo energetico, suggerendo interessanti correlazioni tra diversi tessuti e sistemi [1][2][3][4].In questo interessante riesame della letteratura, appena pubblicata su Endocrine Reviews, gli autori illustrano in maniera esaustiva, lineare e affascinante il metabolismo energetico degli osteoblasti in condizione di benessere dell'organismo, ma anche in condizioni patologiche e illustrano la possibile correlazione e l'impatto sulle malattie ossee metaboliche.Gli osteoblasti, le cellule di origine mesenchimale deputate alla produzione di proteine collageniche e non collageniche dell'osso, formano insieme agli osteoclasti le unità di rimodellamento e sono essenziali per la crescita e la manutenzione del benessere scheletrico. Disturbi clinici di disponibilità del substrato, come possono essere presenti nel diabete mellito, nell'anoressia nervosa e nell'invecchiamento, causano disfunzioni delle cellule osteoblastiche che hanno come conseguenza un'alterazione del rimodellamento con un deterioramento della resistenza scheletrica, un aumento della fragilità e delle fratture osteoporotiche.

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“…Molteplici studi clinici hanno messo in evidenza importanti alterazioni scheletriche in corso di patologie che alterano l'apporto calorico e il metabolismo energetico, suggerendo interessanti correlazioni tra diversi tessuti e sistemi [1][2][3][4].…”