Postmenopausal women with type 1 diabetes (T1D) have the lower volumetric bone-mineral density (vBMD); than their diabetes-free peers, and bone-quality deficits may even greater for those who developed the disease before age 20; according to new findings. “They for the first time showed that the age of onset of type 1 diabetes may have an influence on bone quality,” Major osteoporotic fractures are three times as common in people with T1D, and increases in hip fracture risk appear earlier in women with T1D, Dr. Shah and his team note in Bone.
The gold standard for measuring bone density, areal (a)BMD measured by dual X-ray absorptiometry (DXA); does not accurately predict fracture risk in T1D patients, they add. The authors used peripheral computed tomography (pQCT) to measure bone mass, geometry and estimated bone strength at the non-dominant radius and tibia in 24 postmenopausal women with T1D and 22 controls matched by age, sex, and BMI, all of whom also had DXA of the lumbar spine, hip, and distal radius.
BMI and radius length
There were no differences in aBMD between the T1D group and the control group. After adjusting for age, BMI and radius length, trabecular vBMD and compressive bone strength significantly lower at the distal radius for women with T1D. Women who developed T1D before age 20 had significantly lower adjusted total (259 vs, 351 mg/cm3) and trabecular vBMD (141 vs. 214 mg/cm3) at the distal radius compared with those who developed the disease later.
They also had a larger endosteal circumference and similar periosteal circumference at the tibia; leading to reduced cortical thickness compared to the adult-onset group. Dr. Shah and his colleagues now plan to use pQCT to evaluate bone quality and strength at the hip and lumbar spine.
Unfortunately, they do not have any evidence or evidence-based strategy to say OK; these are the steps to make your bones strong” for women with T1D, the researcher said. In his own practice, Dr. Shah added; the researcher and his colleagues begin DXA screening at age 50 for both men and women with diabetes and prescribe osteoporosis medications; to prevent fracture more aggressively.
DXA-measured bone density alone
Fracture risk in patients with T1D is high; which cannot explain based on DXA-measured bone density alone (2, 6). As expected, there was no difference in DXA-measured aBMD between patients with T1D and controls in our study; despite the fact that 79% of women with T1D had a reported history of fractures.
Most, but not all, studies in children and adolescents with T1D showed smaller bones despite normal growth and lower total vBMD or trabecular vBMD at the distal radius. Most studies evaluating bone health have been carried out in children and adolescents with a shorter duration of T1D. In addition, differences in the characteristics of study populations such as age and Tanner staging makes the comparison of study results difficult