scholarly journals Screening for osteoporosis and fracture risk in women with type 1 diabetes

2021 ◽  
Vol 38 (5) ◽  
pp. 20-22
Author(s):  
Brona Roberts ◽  
Grainne Connolly ◽  
Anthony Lewis ◽  
John Lindsay ◽  
Clodagh Loughrey ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Fracture Risk

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

scholarly journals Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

2016 ◽  
Vol 169 ◽  
pp. 49-54 ◽  
Author(s):  
Norelle R. Reilly ◽  
Benjamin Lebwohl ◽  
Kaziwe Mollazadegan ◽  
Karl Michaëlsson ◽  
Peter H.R. Green ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Fracture Risk ◽  
Young Patients

scholarly journals Recurrent vertebral fractures in a young adult: a closer look at bone health in type 1 diabetes mellitus

2018 ◽  
Vol 2018 ◽  
Author(s):  
Eleanor P Thong ◽  
Sarah Catford ◽  
Julie Fletcher ◽  
Phillip Wong ◽  
Peter J Fuller ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Type 1 Diabetes Mellitus ◽  
Vertebral Fractures ◽  
Bone Health ◽  
Bone Microarchitecture ◽  
List Type ◽  
Secondary Fracture

Summary The association between type 1 diabetes mellitus (T1DM) and bone health has garnered interest over the years. Fracture risk is known to be increased in individuals with T1DM, although bone health assessment is not often performed in the clinical setting. We describe the case of a 21-year-old male with longstanding T1DM with multilevel vertebral fractures on imaging, after presenting with acute back pain without apparent trauma. Dual-energy X-ray absorptiometry (DXA) revealed significantly reduced bone mineral density at the lumbar spine and femoral neck. Extensive investigations for other secondary or genetic causes of osteoporosis were unremarkable, apart from moderate vitamin D deficiency. High-resolution peripheral quantitative computed tomography and bone biospy revealed significant alterations of trabecular bone microarchitecture. It later transpired that the patient had sustained vertebral fractures secondary to unrecognised nocturnal hypoglycaemic seizures. Intravenous zoledronic acid was administered for secondary fracture prevention. Despite anti-resorptive therapy, the patient sustained a new vertebral fracture after experiencing another hypoglycaemic seizure in his sleep. Bone health in T1DM is complex and not well understood. There are significant challenges in the assessment and management of osteoporosis in T1DM, particularly in young adults, where fracture prediction tools have not been validated. Clinicians should be aware of hypoglycaemia as a significant risk factor for fracture in patients with T1DM. Learning points: Type 1 diabetes mellitus (T1DM) is a secondary cause of osteoporosis, characterised by reduced bone mass and disturbed bone microarchitecture. Hypoglycaemic seizures generate sufficient compression forces along the thoracic column and can cause fractures in individuals with compromised bone quality. Unrecognised hypoglycaemic seizures should be considered in patients with T1DM presenting with fractures without a history of trauma. Patients with T1DM have increased fracture risk and risk factors should be addressed. Evaluation of bone microarchitecture may provide further insights into mechanisms of fracture in T1DM. Further research is needed to guide the optimal screening and management of bone health in patients with T1DM.

scholarly journals Estrogen Deficiency Exacerbates Type 1 Diabetes–Induced Bone TNF-α Expression and Osteoporosis in Female Mice

Endocrinology ◽  
2017 ◽  
Vol 158 (7) ◽  
pp. 2086-2101 ◽  
Author(s):  
Sandi Raehtz ◽  
Hayley Bierhalter ◽  
Daniel Schoenherr ◽  
Narayanan Parameswaran ◽  
Laura R. McCabe
Keyword(s):  
Type 1 Diabetes ◽  
Bone Loss ◽  
Fracture Risk ◽  
Volume Fraction ◽  
Estrogen Deficiency ◽  
Bone Volume Fraction ◽  
Number Of Patients ◽  
Tnf Α

Abstract Estrogen deficiency after menopause is associated with rapid bone loss, osteoporosis, and increased fracture risk. Type 1 diabetes (T1D), characterized by hypoinsulinemia and hyperglycemia, is also associated with bone loss and increased fracture risk. With better treatment options, T1D patients are living longer; therefore, the number of patients having both T1D and estrogen deficiency is increasing. Little is known about the mechanistic impact of T1D in conjunction with estrogen deficiency on bone physiology and density. To investigate this, 11-week-old mice were ovariectomized (OVX), and T1D was induced by multiple low-dose streptozotocin injection. Microcomputed tomographic analysis indicated a marked reduction in trabecular bone volume fraction (BVF) in T1D-OVX mice (~82%) that was far greater than the reductions (~50%) in BVF in either the OVX and T1D groups. Osteoblast markers, number, and activity were significantly decreased in T1D-OVX mice, to a greater extent than either T1D or OVX mice. Correspondingly, marrow adiposity was significantly increased in T1D-OVX mouse bone. Bone expression analyses revealed that tumor necrosis factor (TNF)–α levels were highest in T1D-OVX mice and correlated with bone loss, and osteoblast and osteocyte death. In vitro studies indicate that estrogen deficiency and high glucose enhance TNF-α expression in response to inflammatory signals. Taken together, T1D combined with estrogen deficiency has a major effect on bone inflammation, which contributes to suppressed bone formation and osteoporosis. Understanding the mechanisms/effects of estrogen deficiency in the presence of T1D on bone health is essential for fracture prevention in this patient population.

scholarly journals Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes

Bone ◽  
2021 ◽  
Vol 143 ◽  
pp. 115614 ◽  
Author(s):  
Anagha Champakanath ◽  
Amena Keshawarz ◽  
Laura Pyle ◽  
Janet K. Snell-Bergeon ◽  
Viral N. Shah
Keyword(s):  
Risk Assessment ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Osteoporotic Fractures ◽  
Fracture Risk Assessment ◽  
Major Osteoporotic Fractures

Does FRAX estimate fracture risk in patients with type 1 diabetes?

Bone ◽  
2021 ◽  
Vol 143 ◽  
pp. 115753
Author(s):  
Jakob Starup-Linde ◽  
Bente Langdahl ◽  
Torben Harsløf
Keyword(s):  
Type 1 Diabetes ◽  
Fracture Risk

scholarly journals Pancreas–kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes

2013 ◽  
Vol 83 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Lucas E. Nikkel ◽  
Sapna P. Iyer ◽  
Sumit Mohan ◽  
Amy Zhang ◽  
Donald J. McMahon ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Kidney Transplantation ◽  
Fracture Risk ◽  
Pancreas Kidney Transplantation

scholarly journals Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Volha V. Zhukouskaya ◽  
Alla P. Shepelkevich ◽  
Iacopo Chiodini
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Bone Health ◽  
Mineral Density ◽  
X Ray

Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D.

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