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Bone health in subjects with type 1 diabetes for more than 50 years

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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.

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Abbreviations

ACR:

Albumin-to-creatinine ratio

BMD:

Bone mineral density

CTx:

Collagen type 1 C-telopeptide

CVD:

Cardiovascular disease

DXA:

Dual-energy X-ray absorptiometry

eGFR:

Estimated glomerular filtration rate

FSH:

Follicle-stimulating hormone

hsCRP:

High-sensitivity C-reactive protein

LH:

Luteinizing hormone

PDR:

Proliferative diabetic retinopathy

PTHi:

Intact parathyroid hormone

SHBG:

Sex hormone binding globulin

T1D:

Type 1 diabetes

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Acknowledgements

We would like to thank the staff the Joslin Clinical Research Center and the 50-Year Medalists and their families. Additionally, we express our appreciation to Dr. George King for his input.

Funding

The Medalist Study was supported by grants from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (DP3 DK094333-01). Financial support for this work was provided by the NIDDK Diabetic Complications Consortium (DiaComp, www.diacomp.org), grant DK076169’, the Juvenile Diabetes Research Foundation (17-2013-310); and the Beatson Foundation. E.M. was in part supported by the Albert Renold Travel Fellowship of the European Foundation for the Study of Diabetes (EFSD).

Author Contributions

EM analyzed data, interpreted data and wrote the manuscript. SD, SH, SMRF and LT helped collect and analyze the data and edited the manuscript. MK, MB and NN contributed to the content and edited the manuscript. HK conceived and designed the study, analyzed and interpreted data and wrote the manuscript. All authors contributed to, read and approved the final version of the manuscript.

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Authors and Affiliations

  1. Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA

    Ernesto Maddaloni, Stephanie D’Eon, Stephanie Hastings, Liane J. Tinsley, Mogher Khamaisi, Savitri M. R. Fouda & Hillary A. Keenan

  2. Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy

    Ernesto Maddaloni & Nicola Napoli

  3. Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA

    Mary L. Bouxsein

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  1. Ernesto Maddaloni
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  9. Hillary A. Keenan
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Corresponding author

Correspondence to Hillary A. Keenan.

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Ethical standard

The Joslin Committee on Human Studies approved the study protocol.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Maddaloni, E., D’Eon, S., Hastings, S. et al. Bone health in subjects with type 1 diabetes for more than 50 years. Acta Diabetol 54, 479–488 (2017). https://doi.org/10.1007/s00592-017-0973-2

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