Bone mineral density in patients with longstanding type 1 diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes

Omar N Alhuzaim; Evan J H Lewis; Leif E Lovblom; Marina Cardinez; Daniel Scarr; Genevieve Boulet; Alanna Weisman; Julie A Lovshin; Yuliya Lytvyn; Hillary A Keenan; Michael H Brent; Narinder Paul; Vera Bril; David Z I Cherney; Bruce A Perkins

doi:10.1016/j.jdiacomp.2018.12.009

Bone mineral density in patients with longstanding type 1 diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes

J Diabetes Complications. 2019 Nov;33(11):107324. doi: 10.1016/j.jdiacomp.2018.12.009. Epub 2018 Dec 22.

Authors

Affiliations

¹ Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
³ Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁴ Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Research Division, Joslin Diabetes Center, Boston, MA, USA.
⁷ Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, Ontario, Canada.
⁹ The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: bruce.perkins@sinaihealthsystem.ca.

PMID: 31003922
DOI: 10.1016/j.jdiacomp.2018.12.009

Abstract

Aim: It is currently unclear if longstanding type 1 diabetes (T1D) affects bone mineral density (BMD).

Methods: BMD measured by dual-energy X-ray absorptiometry and history of fragility fracture was determined in 75 T1D participants with ≥50 years of diabetes duration and 75 age- and sex-matched non-diabetic controls. BMD T-scores were determined for the lumbar spine (LS), total hip (TH) and femoral neck (FN).

Results: T1D participants had median diabetes duration of 54 [52, 58] years, 41 (55%) were females, and mean A_1c was 7.3 ± 0.8%. T1D females had higher LS T-scores compared to female controls (-0.3 ± 1.2 vs. -1.1 ± 1.4, p = 0.014), lower FN T-scores (-1.5 ± 1.0 vs. -1.2 ± 0.9, p = 0.042) and more fragility fractures (7 (17%) vs. 1 (2%), p = 0.021). In T1D, higher A1c was associated with higher adjusted odds of fragility fracture (p = 0.006). T1D males and controls showed no difference in BMD or fractures.

Conclusions: There were no substantial differences in T-score between T1D and matched controls; however, T1D females showed higher BMD at the LS and possibly paradoxically higher fragility fractures compared to matched controls. These findings suggest that lower T-scores may not be associated with a history of fragility fracture in females with longstanding T1D and that other factors should be investigated.

Keywords: Bone; Bone mineral density; Diabetes complications; Fragility fracture; Type 1 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Absorptiometry, Photon
Aged
Bone Density*
Canada
Diabetes Mellitus, Type 1 / complications
Diabetes Mellitus, Type 1 / physiopathology*
Female
Femur Neck
Fractures, Bone / epidemiology
Fractures, Bone / physiopathology
Humans
Longevity*
Lumbar Vertebrae
Male
Middle Aged
Odds Ratio
Risk Factors
Sex Factors