Risk factors for fragility fractures in type 1 diabetes

Leanza, Giulia; Maddaloni, Ernesto; Pitocco, Dario; Conte, Caterina; Palermo, Andrea; Maurizi, Anna Rita; Pantano, Angelo Lauria; Suraci, C; Altomare, Maria; Strollo, Rocky; Manfrini, Silvia; Pozzilli, Paolo; Schwartz, Ann V.; Napoli, Nicola

doi:10.1016/j.bone.2019.04.017

Cited by 59 publications

(48 citation statements)

References 29 publications

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“…Intensive insulin treatment has been associated with increased BMD in patients with T1D[82]. Consistently, no association between insulin treatment and single nor multiple fractures was found in a recent study that assessed risk factors for fragility fractures in T1D[230].…”

Section: Advanced Glycation End Products-bone Matrix In Diabetesmentioning

confidence: 87%

Bone health in diabetes and prediabetes

Costantini

Conte

2019

WJD

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Bone fragility has been recognized as a complication of diabetes, both type 1 diabetes (T1D) and type 2 diabetes (T2D), whereas the relationship between prediabetes and fracture risk is less clear. Fractures can deeply impact a diabetic patient’s quality of life. However, the mechanisms underlying bone fragility in diabetes are complex and have not been fully elucidated. Patients with T1D generally exhibit low bone mineral density (BMD), although the relatively small reduction in BMD does not entirely explain the increase in fracture risk. On the contrary, patients with T2D or prediabetes have normal or even higher BMD as compared with healthy subjects. These observations suggest that factors other than bone mass may influence fracture risk. Some of these factors have been identified, including disease duration, poor glycemic control, presence of diabetes complications, and certain antidiabetic drugs. Nevertheless, currently available tools for the prediction of risk inadequately capture diabetic patients at increased risk of fracture. Aim of this review is to provide a comprehensive overview of bone health and the mechanisms responsible for increased susceptibility to fracture across the spectrum of glycemic status, spanning from insulin resistance to overt forms of diabetes. The management of bone fragility in diabetic patient is also discussed.

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Section: Advanced Glycation End Products-bone Matrix In Diabetesmentioning

confidence: 87%

Bone health in diabetes and prediabetes

Costantini

Conte

2019

WJD

Self Cite

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“…Two meta-analyses involving a total of 7,832,213 participants found an increased incidence of hip fractures in individuals living with diabetes mellitus compared to the general population, whereby those living with type 1 diabetes mellitus (T1DM) (relative risk (RR)= 5.76–6.3) show a higher incidence than individuals living with type 2 diabetes mellitus (T2DM) (RR = 1.34–1.7) [2,3]. In addition, diabetic fracture risk benefits significantly from effective clinical management, as fracture risk is higher in diabetes mellitus with poor glycemic control compared to adequately controlled diabetes mellitus [4,5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Diabetes Mellitus on Bone Health

Murray

Coleman

2019

IJMS

149

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Long-term exposure to a diabetic environment leads to changes in bone metabolism and impaired bone micro-architecture through a variety of mechanisms on molecular and structural levels. These changes predispose the bone to an increased fracture risk and impaired osseus healing. In a clinical practice, adequate control of diabetes mellitus is essential for preventing detrimental effects on bone health. Alternative fracture risk assessment tools may be needed to accurately determine fracture risk in patients living with diabetes mellitus. Currently, there is no conclusive model explaining the mechanism of action of diabetes mellitus on bone health, particularly in view of progenitor cells. In this review, the best available literature on the impact of diabetes mellitus on bone health in vitro and in vivo is summarised with an emphasis on future translational research opportunities in this field.

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“…High levels of circulating pentosidine and HbA1c are associated with prevalent fractures,50 where each percentage increase in HbA1c increases the OR for any fracture by 1.9. High levels of HbA1c is also associated with fragility fractures with an OR of 4.19 (for each percentage increase) and associated with multiple fractures in patients with T1D 16,51. A cohort study by Thayakaran et al reported an increased fracture risk with increasing HbA1c, although with a more modest risk increase of 1.01 per mmol/mol increase 52.…”

Section: Impact Of Hyperglycemia and Ages On Bone Strength And Fractumentioning

confidence: 99%

<p>Type 1 Diabetes and Bone Fragility: Links and Risks</p>

Starup-Linde

Hygum

Harsløf

et al. 2019

DMSO

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Type 1 diabetes (T1D) is associated with an increased fracture risk, which is present at young and old age. Reductions in bone mineral density do not explain the increased fracture risk. Novel scanning modalities suggest that structural deficits may contribute to the increased fracture risk. Furthermore, T1D may due to insulinopenia be a state of low bone turnover. However, diabetes complications and comorbidities may influence fracture risk. Patients with T1D are fearful of falls. The diabetes related complications, hypoglycemic events, and antihypertensive treatment may all lead to falls. Thus, the increased fracture risk in T1D seems to be multifactorial, and earlier intervention with antiosteoporotic medication and focus on fall prevention is needed. This systematic review addresses the epidemiology of fractures and osteoporosis in patients with T1D and the factors that influence fracture risk.

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Risk factors for fragility fractures in type 1 diabetes

Cited by 59 publications

References 29 publications

Bone health in diabetes and prediabetes

Bone health in diabetes and prediabetes

Impact of Diabetes Mellitus on Bone Health

<p>Type 1 Diabetes and Bone Fragility: Links and Risks</p>

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