Analysis of bone mineral density and relevant factors in patients with type 1 diabetes

Abstract Context Fracture risk in people with type 1 diabetes (T1D) is higher than their peers without diabetes. Objective To compare bone mineral density (BMD) across the lifespan in individuals with T1D and age- and sex-matched healthy controls. Design Cross-sectional. Setting Subjects (5–71 years) with T1D and matched controls from ongoing research studies at Barbara Davis Center for Diabetes. Patients or other participants Participants with lumbar spine BMD by dual X-ray absorptiometry (DXA) were divided into 2 groups: children ≤20 years and adults >20 years. Intervention None. Main outcome measures Comparison of BMD by diabetes status across age groups and sex using a linear least squares model adjusted for age and body mass index (body mass index (BMI) for adults; and BMI z-score in children). Results Lumbar spine BMD from 194 patients with T1D and 156 controls were analyzed. There was no difference in age- and BMI-adjusted lumbar spine BMD between patients with T1D and controls: among male children (least squares mean ± standard error of the mean [LSM ± SEM]; 0.80 ± 0.01 vs 0.80 ± 0.02 g/cm2, P = .98) or adults (1.01 ± 0.03 vs 1.01 ± 0.03 g/cm2, P = .95), and female children (0.78 ± 0.02 vs 0.81 ± 0.02 g/cm2, P = .23) or adults (0.98 ± 0.02 vs 1.01 ± 0.02 g/cm2, P = .19). Lumbar spine (0.98 ± 0.02 vs 1.04 ± 0.02 g/cm2, P = .05), femoral neck (0.71 ± 0.02 vs 0.79 ± 0.02 g/cm2, P = .003), and total hip (0.84 ± 0.02 vs 0.91 ± 0.02, P = .005) BMD was lower among postmenopausal women with T1D than postmenopausal women without diabetes. Conclusion Across age groups, lumbar spine BMD was similar in patients with T1D compared with age- and sex-matched participants without diabetes, except postmenopausal females with T1D had lower lumbar spine, femoral neck, and total hip BMD.

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Changes in Bone Mineral Density in Young Adults with Type 1 Diabetes Mellitus

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0028 ◽

2013 ◽

Vol 20 (3) ◽

pp. 297-306

Author(s):

Monica Goia-Socol ◽

Ileana Duncea ◽

Gabriela Roman ◽

Mihai-Andrei Goia-Socol ◽

Daniel-Corneliu Leucuţa ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Femoral Neck ◽

Type 1 Diabetes Mellitus ◽

Bone Mineral ◽

Young Patients ◽

Mineral Density

Abstract Background and aims: Type 1 diabetes mellitus (T1DM) represents a secondary cause of osteoporosis. Our aim was to determine bone mineral density (BMD) changes in a group of young Romanian adults with T1DM and to analyze the factors related to this disease that could have had an impact on bone mass. Material and Methods: Fifty-two young patients with T1DM were compared to 37 healthy volunteers matched for body mass index (BMI). All subjects had their BMD measured at the hip and lumbar spine. Results: We found no statistically significant differences in BMD between T1DM patients and controls (p=0.618 for lumbar spine, p=0.974 for femoral neck and p=0.883 for total hip). Multiple linear regression models detected BMI (p =0.043), smoking (p=0.001) and milk intake (p=0.004 for lumbar spine) as significant BMD determinants. In contrast, no associations were found between BMD and metabolic control, daily insulin dose or presence of diabetic retinopathy and/or neuropathy. Long diabetes duration was negatively associated with BMD in femoral neck (p=0.012). Conclusions: Although we couldn’t find differences between BMD in T1DM patients and controls, the link between diabetes duration and BMD that we found suggests that even young patients with long standing T1DM should have their BMD measured

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Bone mineral density at femoral neck and lumbar spine in adults with type 1 diabetes: a meta-analysis and review of the literature

Osteoporosis International ◽

10.1007/s00198-017-4097-x ◽

2017 ◽

Vol 28 (9) ◽

pp. 2601-2610 ◽

Cited By ~ 34

Author(s):

V. N. Shah ◽

K. K. Harrall ◽

C. S. Shah ◽

T. L. Gallo ◽

P. Joshee ◽

...

Keyword(s):

Bone Mineral Density ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Femoral Neck ◽

Bone Mineral ◽

Meta Analysis ◽

Review Of The Literature ◽

Mineral Density

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Bone mineral density predictors in long-standing type 1 and type 2 diabetes mellitus

BMC Endocrine Disorders ◽

10.1186/s12902-021-00815-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefana Catalina Bilha ◽

Letitia Leustean ◽

Cristina Preda ◽

Dumitru D. Branisteanu ◽

Laura Mihalache ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Lumbar Spine ◽

Femoral Neck ◽

Bone Mineral ◽

Mineral Density ◽

Cross Sectional ◽

The Impact

Abstract Background Despite the increased fracture risk, bone mineral density (BMD) is variable in type 1 (T1D) and type 2 (T2D) diabetes mellitus. We aimed at comparing independent BMD predictors in T1D, T2D and control subjects, respectively. Methods Cross-sectional case-control study enrolling 30 T1D, 39 T2D and 69 age, sex and body mass index (BMI) – matched controls that underwent clinical examination, dual-energy X-ray absorptiometry (BMD at the lumbar spine and femoral neck) and serum determination of HbA1c and parameters of calcium and phosphate metabolism. Results T2D patients had similar BMD compared to T1D individuals (after adjusting for age, BMI and disease duration) and to matched controls, respectively. In multiple regression analysis, diabetes duration – but not HbA1c- negatively predicted femoral neck BMD in T1D (β= -0.39, p = 0.014), while BMI was a positive predictor for lumbar spine (β = 0.46, p = 0.006) and femoral neck BMD (β = 0.44, p = 0.007) in T2D, besides gender influence. Age negatively predicted BMD in controls, but not in patients with diabetes. Conclusions Long-standing diabetes and female gender particularly increase the risk for low bone mass in T1D. An increased body weight partially hinders BMD loss in T2D. The impact of age appears to be surpassed by that of other bone regulating factors in both T1D and T2D patients.

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Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis

10.2337/figshare.14618409 ◽

2021 ◽

Author(s):

Phoebe Loxton ◽

Kruthika Narayan ◽

Craig F Munns ◽

Maria E Craig

Keyword(s):

Bone Mineral Density ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Bone Mineral ◽

Meta Analysis ◽

Inclusion Criteria ◽

Mineral Density ◽

Multiple Modalities ◽

Meta Regression

Background There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD), however findings in youth are inconsistent. Purpose Systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: dual energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and/or quantitative ultrasound (QUS). Data Sources PubMed, Embase, Scopus and Web of Science from 01/01/1990 to 31/12/2020, limited to humans, without language restriction. Study Selection Inclusion criteria: cross sectional or cohort studies that included BMD measured either by DXA, pQCT and/or QUS in youth (age <20 years) with type 1 diabetes and matched controls. Data extraction Total body (TB), lumbar spine (LS) and femoral BMD (DXA); tibia, radius and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference (SMD) were estimated and meta-regression was performed using age, diabetes duration and HbA1c as covariates. Data Synthesis We identified 1300 non-duplicate studies; 46 met the inclusion criteria, including 2617 cases and 3851 controls. Mean age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: TB (WMD -0.04 g/cm2, 95% CI -0.06 to -0.02, P=0.0006); LS (-0.02 g/cm2, -0.03 to -0.0, P = 0.01); femur (-0.04 g/cm2, -0.05 to -0.03, P<0.00001); tibial trabecular (-11.32 g/cm3,-17.33 to -5.30, P=0.0002), radial trabecular (-0.91, -1.55 to -0.27, P=0.005); phalangeal (-0.32, -0.38 to -0.25, P<0.00001) and calcaneal (SMD -0.69, -1.11 to -0.26, P=0.001). Using meta-regression TB BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031, P=0.002), but not longer diabetes duration or HbA1c. Limitations Meta-analysis was limited by the small number of studies using QUS and pQCT and lack of use BMD z-scores in all studies. Conclusions Bone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.

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Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis

10.2337/figshare.14618409.v1 ◽

2021 ◽

Author(s):

Phoebe Loxton ◽

Kruthika Narayan ◽

Craig F Munns ◽

Maria E Craig

Keyword(s):

Bone Mineral Density ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Bone Mineral ◽

Meta Analysis ◽

Inclusion Criteria ◽

Mineral Density ◽

Multiple Modalities ◽

Meta Regression

Background There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD), however findings in youth are inconsistent. Purpose Systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: dual energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and/or quantitative ultrasound (QUS). Data Sources PubMed, Embase, Scopus and Web of Science from 01/01/1990 to 31/12/2020, limited to humans, without language restriction. Study Selection Inclusion criteria: cross sectional or cohort studies that included BMD measured either by DXA, pQCT and/or QUS in youth (age <20 years) with type 1 diabetes and matched controls. Data extraction Total body (TB), lumbar spine (LS) and femoral BMD (DXA); tibia, radius and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference (SMD) were estimated and meta-regression was performed using age, diabetes duration and HbA1c as covariates. Data Synthesis We identified 1300 non-duplicate studies; 46 met the inclusion criteria, including 2617 cases and 3851 controls. Mean age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: TB (WMD -0.04 g/cm2, 95% CI -0.06 to -0.02, P=0.0006); LS (-0.02 g/cm2, -0.03 to -0.0, P = 0.01); femur (-0.04 g/cm2, -0.05 to -0.03, P<0.00001); tibial trabecular (-11.32 g/cm3,-17.33 to -5.30, P=0.0002), radial trabecular (-0.91, -1.55 to -0.27, P=0.005); phalangeal (-0.32, -0.38 to -0.25, P<0.00001) and calcaneal (SMD -0.69, -1.11 to -0.26, P=0.001). Using meta-regression TB BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031, P=0.002), but not longer diabetes duration or HbA1c. Limitations Meta-analysis was limited by the small number of studies using QUS and pQCT and lack of use BMD z-scores in all studies. Conclusions Bone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.

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Bone mineral density in young Chilean patients with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0097 ◽

2016 ◽

Vol 29 (6) ◽

Cited By ~ 6

Author(s):

Constanza Mosso ◽

María Isabel Hodgson ◽

Tamara Ortiz ◽

Maria Loreto Reyes

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Vitamin D ◽

Type 1 Diabetes ◽

Lumbar Spine ◽

Serum Calcium ◽

Nutrient Intake ◽

Mineral Density ◽

Vitamin D Levels

AbstractIn this study, our aim was to analyze bone mineral density (BMD) in patients with type 1 diabetes mellitus (T1DM) and compare them with a healthy reference population; in addition, we aimed to observe the association between BMD and the following variables: age at onset, disease duration, metabolic control, pubertal stage, level of physical activity, clinical parameters and nutrient intake.A total of 30 patients with T1DM were included in the study. BMD was determined using dual-energy X-ray densitometry (DXA). Participants with a z-score of values ≥–1 were accepted as normal; BMDs between –2 and –1 were defined as being in the low range of normality; ≤–2 were defined as having low BMD. The 25-hydroxy vitamin D level was classified as sufficient (30–100 ng/mL), insufficient (20–30 ng/mL), and deficient (<20 ng/mL).The percentages of patients with deficient and insufficient 25(OH) vitamin D levels were 50% and 45.8%, respectively. Lumbar spine (LS2–LS4) BMD, total body (TB) BMD and femoral neck (FN) BMD were found in the normal range for more than 80% of the subjects, with no significant differences due to gender. No strong correlations between clinical variables, biochemical parameters and nutrient intake were observed; however, a moderate positive correlation was found between serum calcium and LS2–LS4 BMD (p<0.05). Regression analysis showed that serum calcium, duration of diabetes and intake of sodium and protein are significant factors in determining LS2–LS4 BMD and TB BMD.Patients with T1DM had a normal mean BMD at all sites evaluated, except for two patients who had low BMD at the lumbar spine. More than 95% of patients had insufficient or deficient vitamin D levels. With respect to all the variables studied, serum calcium presented the highest significant correlation with LS2–LS4 BMD.

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Serum interleukin-6 levels and bone mineral density at the femoral neck in post-menopausal women with Type 1 diabetes

Diabetic Medicine ◽

10.1046/j.1464-5491.2003.00953.x ◽

2003 ◽

Vol 20 (6) ◽

pp. 475-480 ◽

Cited By ~ 12

Author(s):

D. Rachoń ◽

J. Myśliwska ◽

K. Suchecka-Rachoń ◽

B. Semetkowska-Jurkiewicz ◽

K. Zorena ◽

...

Keyword(s):

Bone Mineral Density ◽

Type 1 Diabetes ◽

Femoral Neck ◽

Bone Mineral ◽

Interleukin 6 ◽

Mineral Density ◽

Menopausal Women ◽

Post Menopausal

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AB0915 BONE MINERAL DENSITY AND FRACTURE FREQUENCY IN PREMENOPAUSAL WOMEN WITH RHEUMATIC DISEASES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2740 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1759.2-1759

Author(s):

N. Toroptsova ◽

O. Dobrovolskaya ◽

O. Nikitinskaya ◽

N. Demin ◽

A. Smirnov ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Lumbar Spine ◽

Serum Vitamin ◽

Premenopausal Women ◽

Healthy Controls ◽

C Reactive Protein ◽

Mineral Density ◽

Serum Vitamin D ◽

Reactive Protein

Background:The onset of the disease in young and middle age is typical for rheumatic diseases (RDS), but most studies on osteoporosis were conducted in patients (pts) older than 50 years, which included postmenopausal women.Objectives:To assess bone mineral density (BMD), fracture frequency and the factors associated with low BMD in premenopausal women with RDs.Methods:160 women (median age, 36 [29; 43] years): 120 pts with RDs (43 rheumatoid arthritis (RA), 53 systemic sclerosis (SSc) and 24 psoriatic arthritis (PsA)) and 40 age-matched healthy controls were enrolled in the study. We performed a dual-energy X-ray absorptiometry (DXA, Hologic Discovery A, USA) to measure BMD in lumbar spine, femoral neck and total hip. BMD decreasing grade was evaluated by the Z-score <-2SD. All pts were interviewed using a unified questionnaire including assessment of daily dietary calcium intake. Serum vitamin D, C-reactive protein and erythrocyte sedimentation rate (ESR) measurements were done.Results:25% pts with RDs and only 8% healthy controls have low BMD (p=0.02). RA, SSc and PsA pts had low BMD in 37%, 21% and 13%, respectively, that was more often than in healthy women (p=0.004, p=0.046 and p= 0.081, respectively). 9,3% RA pts and 7,5% SSc pts had low energy fractures. BMD of RDs pts in all areas of measurement demonstrated a direct correlation with height, weight, body mass index, and serum vitamin D concentration and an inverse correlation with the cumulative dose of glucocorticoids. Also, proximal femur BMD inversely correlated with RDs duration. BMD of femoral neck and total hip inversely correlated with C-reactive protein level in SSc pts. In RA women we found a direct correlation between lumbar spine and femur neck BMD and ESR.Conclusion:25% of premenopausal women with RDs had reduced BMD and needed monitoring and osteoporosis prevention, while 9.3% pts with RA and 7.5% women with SSc needed anti-osteoporotic treatment.Disclosure of Interests:None declared

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AB0910 SARCOPENIA AND BONE MINERAL DENSITY IN MEN WITH CORONARY HEART DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5401 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1757.2-1757

Author(s):

T. Raskina ◽

I. Grigoreva ◽

J. Averkieva ◽

A. Kokov ◽

V. Masenko

Keyword(s):

Bone Mineral Density ◽

Coronary Heart Disease ◽

Heart Disease ◽

Lumbar Spine ◽

Femoral Neck ◽

Muscle Mass ◽

Bone Mineral ◽

Mineral Density ◽

Group 3 ◽

Group 2

Objectives:To examine bone mineral density (BMD) in men with coronary heart disease (CHD), depending on the state of the muscle mass, strength and function.Methods:79 men aged over 50 years with verified CHD were examined (mean age 63 (57; 66) years).The BMD and T-criterion (standart deviation, SD) of the femoral neck and lumbar spine (L1-L4) were evaluated using dual-energy x-ray absorptiometry (DXA) on the Lunar Prodigy Primo bone densitometer (USA). The following reference intervals were used: normal BMD values (T-criterion ≥-1), osteopenia (OPe) (T-criterion from -1 to -2.5), and osteoporosis (OP) (T-criterion <-2.5).To assess muscle mass, the total area (cm2) of the lumbar muscles of the axial section at the level of the 3rd lumbar vertebra (L3) was determined using multispiral computed tomography on a 64-slice computer tomograph “Somatom Sensation 64” (Siemens AG Medical Solution, Germany). The ratio of the obtained index of the area of skeletal muscle to the square of the patient’s growth index determined the “ skeletalmuscular index L3” (SMI). The media considered the threshold value to be 52.4 cm2/m2.Results:The femoral neck BMD in the examined patients was 0.96 (0.89; 1.03) g/cm2, which corresponds to -0.50 (-1.00; 0) SD according to the T-criterion, in the lumbar spine -1.23 (1.11; 1.32) g/cm2and 0.4 (-0.50; 1.20) SD according to the T-criterion.In accordance with the recommendations of the European working group on sarcopenia in Older people (EWGSOP, 2010, 2018), the patients were divided into 3 groups: 31 patients without sarcopenia (group 1), 21 patients with isolated muscle loss (presarcopenia) (group 2) and 27 patients with sarcopenia (group 3).BMD in the femoral neck in the group of patients without sarcopenia was 0.96 (0.72; 1.26) g/cm2, which corresponds to -0.50 (-0.8; 0.2) SD according to the T-criterion, in the lumbar spine – 1.19 (1.10; 1.275) g/cm2and 0.1 (-0.6; 0.8) SD according to the T-criterion. BMD in the femoral neck in the group of patients with presarcopenia (group 2) – 0.995 (0.94; 1.04) g/cm2and -0.3 (-0.70; 0) SD according to the T-criterion, in the lumbar spine – 1.32 (1.24; 1.40) g/cm2and 1.20 (0.50; 1.90) SD according to the T-criterion. In patients with established sarcopenia (group 3), the following indicators of BMD and T-criterion were recorded: 0.95 (0.845; 0.98) g/cm2and -0.60 (-1.40; -0.40) SD and 1.23 (0.085; 1.31) g/cm2and 0.4 (-0.8; 1.1) SD in the femoral neck and lumbar spine, respectively.A comparative analysis of the results of the DXA found that patients with sarcopenia had a significant decrease in the BMD and T-criterion in the femoral neck compared to patients with presarcopenia (p=0.039 and p=0.040, respectively). There were no differences between the groups of patients without sarcopenia and with sarcopenia and presarcopenia (p>0.05).It was found that patients with sarcopenia had significantly lower BMD and T-criterion in the lumbar spine compared to patients with presarcopenia (p=0.017 and p=0.0165, respectively). The values of the BMD and T-criterion in the groups of patients without sarcopenia and with presarcopenia and sarcopenia in the lumbar spine were comparable (p>0.05).Conclusion:The presence of sarcopenia is associated with loss of BMD in the femoral neck and in the lumbar spine. The results obtained confirm the high probability of common pathogenetic links between OP and sarcopenia.Disclosure of Interests:None declared

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