Poor glycemic control is associated with low BMD detected in premenopausal women with type 1 diabetes

Abstract

Introduction Low BMD and fracture may be complications of type 1 diabetes. We sought to determine the roles of bone turnover and glycemic control in the etiology of low BMD. Methods Premenopausal women from the Wisconsin Diabetes Registry Study and matched controls were compared (n=75 pairs). Heel and forearm BMD were measured, and hip and spine BMD were measured in a subset. Markers of bone formation (osteocalcin) and resorption (NTx), and glycemic control (HbA1c) were determined. Results Age ranged from 18–50 years with a mean of 28, and 97% were Non-Hispanic white. Among women with diabetes, mean disease duration was 16 years and current HbA1c was 8%. Compared to controls, women with diabetes had a high prevalence of previous fracture (37% vs. 24%) and low BMD for age (heel or forearm: 49% vs. 31%), low heel and forearm BMD, and low osteocalcin levels. Levels of NTx were similar, suggesting uncoupled turnover favoring resorption. Poor glycemic control was associated with low BMD at all bone sites except the spine, and with low osteocalcin and NTx levels. Conclusions Optimal glycemic control may prevent low BMD and altered bone turnover in type 1 diabetes, and decrease fracture risk.

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

“…Some (45,56) have reported no difference in the BMD between diabetics and controls, whereas others (51,52,53,54,55,57) have documented a decrease in either trabecular and/or cortical BMD at these sites. F/M, female/male; Duration, duration of diabetes in years; Site, skeletal site demonstrating a decreased bone mineral density (BMD); MVC, correlation between BMD and diabetic microvascular complication(s); GC, correlation between BMD and glycaemic control (usually the mean HbA1c); NR, not reported; H, hip; S, spine; TB, total body; Hip*, only site measured; Spine*, only site measured.…”

“…A number of studies have documented a smaller crosssectional radial or tibial bone area in T1DM compared to controls (51,56,57), especially during childhood (57,64), but with a normalization with age (65), and reported an association between glycaemic control and decreased bone size (52,54).…”

“…A few studies (45,51,52,53,54,55,56,57) have employed peripheral quantitative computer tomography (pQCT) or peripheral DXA (pDXA) to study the BMD of the distal forearm or tibia in T1DM. Some (45,56) have reported no difference in the BMD between diabetics and controls, whereas others (51,52,53,54,55,57) have documented a decrease in either trabecular and/or cortical BMD at these sites.…”

Alteration of the bone tissue material properties in type 1 diabetes mellitus: A Fourier transform infrared microspectroscopy study

“…Another more likely explanation could reside in a direct effect of diabetes on bone tissue. Bone mineral density (BMD), measured by dual energy X-ray absorptiometry, has been reported to be lower in T1DM patients as compared to age-matched control subjects [5,6]. However, elevated fracture risk among T1DM patients still persists even after adjusting for hip BMD [7].…”

Gender differences in sclerostin and clinical characteristics in type 1 diabetes mellitus

“…A reduced bone formation as a consequence of reduced osteoblast activity has been identified as the mean pathogenetic effect or for low bone mineral density (BMD) in subjects with T1DM (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39). intimal thickening in atherosclerosis, and Wnt/b-catenin signaling is a regulator of VSMC behavior (9).…”