Comparison of osteoporosis in US adults with type 1 and type 2 diabetes mellitus

J Endocrinol Invest. 2018 Sep;41(9):1051-1060. doi: 10.1007/s40618-018-0828-x. Epub 2018 Jan 20.


Purpose: We examined bone mineral density (BMD) and osteoporosis prevalence in those with type 1 compared to type 2 diabetes derived from a nationally representative sample from the civilian community in the United States.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) for 2005-2006, 2007-2008, 2009-2010, and 2013-2014 were merged to obtain a large sample of diabetics at least 20 years of age with participation in the interview and medical examination. Osteoporosis status was defined by BMD at the total femur, femoral neck, or total lumbar spine. Self-reported diabetics that were prescribed insulin within the first year of diagnosis, are currently taking insulin, and reported no prescriptions for any diabetic pills were classified as type 1. Remaining self-reported diabetics were deemed as having type 2.

Results: A total of 2050 diabetics were included in which 87 (4%) were classified as type 1. Type 1 diabetics were found to have a significantly lower BMD at the total femur and femoral neck, but not at the lumbar spine in the adjusted models. Diabetics with type 1 were 4.7 times more likely to have osteoporosis than those with type 2. There was no significant relationship between diabetes type and BMD or osteoporosis prior to adjustment for confounders.

Conclusions: Although our results show an increased likelihood of osteoporosis among those with type 1 diabetes, future studies including a larger sample from a community population are needed. It may benefit diabetics, especially those with type 1, to initiate osteoporosis screening methods including evaluation of fracture risk, bone quality, and BMD measurements at multiple sites earlier than recommended.

Keywords: Bone mineral density; Dual-energy X-ray absorptiometry; Osteoporosis; Type 1 diabetes mellitus; Type 2 diabetes mellitus.

Publication types

  • Comparative Study

MeSH terms

  • Absorptiometry, Photon / methods
  • Adult
  • Aged
  • Bone Density / physiology
  • Diabetes Mellitus, Type 1 / diagnostic imaging*
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetes Mellitus, Type 2 / diagnostic imaging*
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Female
  • Femur Neck / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys / trends
  • Osteoporosis / diagnostic imaging*
  • Osteoporosis / epidemiology*
  • Self Report / standards
  • United States / epidemiology