Ernesto Maddaloni1,2, Stephanie D'Eon1, Stephanie Hastings1, Liane J Tinsley1, Nicola Napoli2, Mogher Khamaisi1, Mary L Bouxsein3, Savitri M R Fouda1, Hillary A Keenan4. 1. Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA. 2. Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy. 3. Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA. 4. Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA. hillary.keenan@joslin.harvard.edu.
Abstract
AIMS: Few data regarding prevalence of and risk factors for poor bone health in aging individuals with long-standing T1D are available. In this study, we aim to describe the prevalence of bone fragility and to identify factors associated with low bone density in individuals with long-term T1D. METHODS: We examined the prevalence of non-vertebral fractures in 985 subjects enrolled in the Joslin 50-Year Medalist Study and measured bone mineral density (BMD) by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine and radius in a subset (65 subjects, mean age 62.6 years, duration 52.5 years, HbA1c 7.1%) with no significant clinical or demographic differences from the rest of the cohort. RESULTS: Medalists have low prevalence of fractures (0.20% hip and 0.91% wrist) and normal Z-score values (spine +1.15, total hip +0.23, femoral neck -0.01, radius +0.26; p > 0.05 for differences vs. 0 at all sites). A significant relationship was found between lower BMD and higher total cholesterol, triglycerides and LDL levels, but not HbA1c. Low BMD at the femoral neck was associated with cardiovascular disease after adjustment for confounding factors: prevalence risk ratio of CVD [95% CI] 4.6 [1.2-18.1], p = 0.03. No other diabetic vascular complication was found to be associated with low BMD. CONCLUSIONS: These are the first data regarding bone health in aging individuals who have had diabetes for 50 or more years. The low rates of non-vertebral fractures and the normal Z-score suggest the long T1D diabetes duration did not increase the risk of bone fractures in Medalists compared to non-diabetic peers. Additionally, the association with cardiovascular disease demonstrates the BMD differences in groups are likely not due to glycemic control alone.
AIMS: Few data regarding prevalence of and risk factors for poor bone health in aging individuals with long-standing T1D are available. In this study, we aim to describe the prevalence of bone fragility and to identify factors associated with low bone density in individuals with long-term T1D. METHODS: We examined the prevalence of non-vertebral fractures in 985 subjects enrolled in the Joslin 50-Year Medalist Study and measured bone mineral density (BMD) by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine and radius in a subset (65 subjects, mean age 62.6 years, duration 52.5 years, HbA1c 7.1%) with no significant clinical or demographic differences from the rest of the cohort. RESULTS: Medalists have low prevalence of fractures (0.20% hip and 0.91% wrist) and normal Z-score values (spine +1.15, total hip +0.23, femoral neck -0.01, radius +0.26; p > 0.05 for differences vs. 0 at all sites). A significant relationship was found between lower BMD and higher total cholesterol, triglycerides and LDL levels, but not HbA1c. Low BMD at the femoral neck was associated with cardiovascular disease after adjustment for confounding factors: prevalence risk ratio of CVD [95% CI] 4.6 [1.2-18.1], p = 0.03. No other diabetic vascular complication was found to be associated with low BMD. CONCLUSIONS: These are the first data regarding bone health in aging individuals who have had diabetes for 50 or more years. The low rates of non-vertebral fractures and the normal Z-score suggest the long T1D diabetes duration did not increase the risk of bone fractures in Medalists compared to non-diabetic peers. Additionally, the association with cardiovascular disease demonstrates the BMD differences in groups are likely not due to glycemic control alone.
Entities:
Keywords:
Aging; Bone fractures; Bone mineral density; Low bone mass; Osteoporosis; Type 1 diabetes
Authors: Joshua N Farr; Matthew T Drake; Shreyasee Amin; L Joseph Melton; Louise K McCready; Sundeep Khosla Journal: J Bone Miner Res Date: 2014-04 Impact factor: 6.741
Authors: Elsa S Strotmeyer; Jane A Cauley; Trevor J Orchard; Ann R Steenkiste; Janice S Dorman Journal: Diabetes Care Date: 2006-02 Impact factor: 19.112
Authors: H Lunt; C M Florkowski; T Cundy; D Kendall; L J Brown; J R Elliot; J E Wells; J G Turner Journal: Diabetes Res Clin Pract Date: 1998-04 Impact factor: 5.602
Authors: Laura M Yerges-Armstrong; Haiqing Shen; Kathleen A Ryan; Elizabeth A Streeten; Alan R Shuldiner; Braxton D Mitchell Journal: J Clin Endocrinol Metab Date: 2013-10-08 Impact factor: 5.958
Authors: Zhiheng H He; Stephanie A D'Eon; Liane J Tinsley; Shane Fitzgerald; Stephanie M Hastings; Mogher Khamaisi; Jennifer K Sun; Sara J Turek; Ernst J Schaefer; George L King; Hillary A Keenan Journal: Diabetes Care Date: 2015-05 Impact factor: 19.112
Authors: Hema Kalyanaraman; Gerburg Schwaerzer; Ghania Ramdani; Francine Castillo; Brian T Scott; Wolfgang Dillmann; Robert L Sah; Darren E Casteel; Renate B Pilz Journal: Diabetes Date: 2018-01-04 Impact factor: 9.461
Authors: Bruce A Perkins; Leif Erik Lovblom; Sebastien O Lanctôt; Krista Lamb; David Z I Cherney Journal: Diabetologia Date: 2021-03-04 Impact factor: 10.122
Authors: Olivia McCarthy; Othmar Moser; Max L Eckstein; Rachel Deere; Steve C Bain; Jason Pitt; Richard M Bracken Journal: Front Endocrinol (Lausanne) Date: 2019-08-02 Impact factor: 5.555
Authors: Mohammed A Alharbi; Citong Zhang; Chanyi Lu; Tatyana N Milovanova; Leah Yi; Je Dong Ryu; Hongli Jiao; Guangyu Dong; J Patrick O'Connor; Dana T Graves Journal: Diabetes Date: 2018-10-02 Impact factor: 9.461