Calcified Tissue International

, Volume 58, Issue 5, pp 316–319 | Cite as

Bone mineral density measured by dual X-ray absorptiometry in Spanish patients with insulin-dependent diabetes mellitus

  • M. Muñoz-Torres
  • E. Jódar
  • F. Escobar-Jiménez
  • P. J. López-Ibarra
  • J. D. Luna
Clinical Investigations


Previous studies suggest that low bone mass is a potential complication of insulin-dependent diabetes mellitus. Nevertheless, the factors that influence diabetic osteopenia are not well established. In order to evaluate the prevalence and magnitude of diabetic osteopenia and its association with clinical and metabolic variables, we studied 94 consecutive patients with insulin-dependent diabetes mellitus. Their age ranged from 20 to 56 years and duration of diabetes varied from 1 to 35 years. Bone mineral density (BMD) was measured by dual X-ray absorptiometry at lumbar spine and proximal femur and the values were expressed as z-score. The presence and extent of microvascular complications, degree of metabolic control, and other risk factors for osteoporosis were recorded and some biochemical markers of bone metabolism were assessed. Diabetic patients showed reduced BMD in all sites (lumbar spine: −0.89±1.21; femoral neck: −0.99±1.24; Ward triangle; −1.05±1.24;P<0.0001). Of the 94 patients 19.1% met diagnostic criteria for osteoporosis. BMD correlated with body mass index in all sites and with the duration of disease in Ward's triangle. Presence and extent of diabetic complications were associated with lower BMD, as was smoking. No correlation was found between BMD and biochemical markers. In conclusion, osteopenia is a common complication in patients with insulin-dependent diabetes mellitus. Microvascular complications are a critical point in the progression of diabetic osteopenia. Other risk factors for osteoporosis (nutritional status and smoking) must be taken into account.

Key words

Insulin-dependent diabetes mellitus Bone mineral density Dual X-ray absorptiometry Bone turnover markers Microvascular complications 


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  1. 1.
    Selby PL (1988) Osteopenia and diabetes. Diabetic Med 5: 423–428PubMedGoogle Scholar
  2. 2.
    Bouillon R (1991) Diabetic bone disease. Calcif Tissue Int 49: 155–160PubMedGoogle Scholar
  3. 3.
    Compston JE, Smith EM, Matthews C, Schofield P (1994) Whole body composition and regional bone mass in women with insulin-dependent diabetes mellitus. Clin Endocrinol 41: 289–293Google Scholar
  4. 4.
    Seino Y, Ishida H (1995) Diabetic osteopenia: pathophysiology and clinical aspects. Diabetes Metab Rev 11:21–35PubMedCrossRefGoogle Scholar
  5. 5.
    Burkhardt R, Moser W, Bartl R, Mahl G (1981) Is diabetic osteoporosis due to microangiopathy? Lancet i:844CrossRefGoogle Scholar
  6. 6.
    Mathiassen B, Nielsen S, Johansen JS, Hartwell D, Ditzel J, Rodbro P, Christiansen C (1990) Long-term bone loss in insulin-dependent diabetes patients with microvascular complications. J Diabetic Complications 4:145–149CrossRefGoogle Scholar
  7. 7.
    Craig R, Rowe D, Kream B (1984) Regulation of bone collagen synthesis and procollagen mRNA levels by insulin. Calcif Tissue Int 36:557–561Google Scholar
  8. 8.
    Muñoz-Torres M, Díaz Pérez de Madrid J, Escobar Jiménez F, Ortego N, González A, García-Calvente C (1991) Alterations of mineral metabolism in type 1 (insulin-dependent) diabetic patients (abstract). Diabetologia 34(suppl 2):A164Google Scholar
  9. 9.
    Verrotti A, Chiarelli F, Capani F, Morgese G (1992) Calcium metabolism in type I diabetes mellitus. Diabetes Nutr Metab 5:231–236Google Scholar
  10. 10.
    Brownlee M (1990) Collagen changes in diabetes: basic aspects and clinical implications. In: Belfiore F, Molinatti GM, Reaven GM (eds) Tissue-specific metabolic alterations in diabetes. Karger Gmbh, Bassel, pp 54–60Google Scholar
  11. 11.
    Levin ME, Boisseau VC, Avioli LV (1976) Effects of diabetes mellitus on bone mass in juvenile and adult onset diabetes. N Engl J Med 294:241–245PubMedCrossRefGoogle Scholar
  12. 12.
    Santiago JV, McAlister WH, Ratzan SK, Bussman Y, Haymond G, Shackelford G, Weldon VV (1977). Decreased cortical thickness and osteopenia in children with diabetes mellitus. J Clin Endocrinol Metab 45:845–848PubMedGoogle Scholar
  13. 13.
    Hui SL, Epstein S, Johnston C (1985) Bone mass in type I diabetes. J Clin Endocrinol Metab 60:74–80PubMedGoogle Scholar
  14. 14.
    McNair P (1988) Bone mineral metabolism in human type I (insulin-dependent) diabetes mellitus. Dan Med Bull 35:109–121PubMedGoogle Scholar
  15. 15.
    Gallacher SJ, Fenner JAK, Fisher BN, Gallacher SJ, Fenner JAK, Fisher BN, Kuin JD, Fraser WD, Logue FC, Cowan RA, Boyle IT, MacCuish AC (1993) An evaluation of bone density and turnover in premenopausal women with type 1 diabetes mellitus. Diabetic Med 10:129–133PubMedGoogle Scholar
  16. 16.
    Olmos JM, Perez-Castrillon JL, García MT, Garrido JC, Amado JA, González-Macías J (1994) Bone densitometry and biochemical bone remodeling markers in type 1 diabetes mellitus. Bone Miner 26:1–8PubMedCrossRefGoogle Scholar
  17. 17.
    Kayath MJ, Dib SA, Vieira JGH (1994) Prevalence and magnitude of osteopenia associated with insulin-dependent diabetes mellitus. J Diabetic Complications 8:97–104CrossRefGoogle Scholar
  18. 18.
    World Health Organization Study Group (1985) Diabetes Mellitus. World Health Organization Technical Reports Series No. 727, GenevaGoogle Scholar
  19. 19.
    Díaz Curiel M, Castro N (1992) Bone mineral density in the Spanish population measured by dual X-ray absorptiometry (DEXA) (abstract). Bone Miner 17(suppl 1):133Google Scholar
  20. 20.
    World Health Organization Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organization Technical Reports Series No. 843, GenevaGoogle Scholar
  21. 21.
    Hansen MA, Hassager C, Overgaard K, Marslew U, Riis B, Christiansen C (1990) Dual energy X-ray absorptiometry: a precise method of measuring bone mineral density in the lumbar spine. J Nucl Med 31:1156–1162PubMedGoogle Scholar
  22. 22.
    Ponder SW, McCormick DP, Fawcet HD, Tran AD, Ogelsby GW, Brouhard BH, Travis LB (1992) Bone mineral density of the lumbar vertebrae in children and adolescents with insulin-dependent diabetes mellitus. J Pediatr 120:541–545PubMedCrossRefGoogle Scholar
  23. 23.
    Wagasuki M, Wakao R, Tawata M, Gan N, Koizumi K, Onaya T (1993) Bone mineral density measured by dual energy X-ray absorptiometry in patients with non-insulin-dependent diabetes mellitus. Bone 14:29–33CrossRefGoogle Scholar
  24. 24.
    Rishaug U, Birkeland KI, Falch JA, Vaaler S (1995) Bone mass in non-insulin-dependent diabetes mellitus. Scand J Clin Lab Invest 55:257–262PubMedGoogle Scholar
  25. 25.
    van Daele PLA, Stolk RP, Burger H, Algra D, Grobbee DE, Hofman A, Birkenhager JC, Pols HAP (1995) Bone density in non-insulin-dependent diabetes mellitus. Ann Intern Med 122: 409–414PubMedGoogle Scholar
  26. 26.
    Verhaeghe J, Van Herck E, Visser WJ, Suiker AMH, Thomasset M, Einhorn TA, Faierman E, Bouillon R (1990) Bone and mineral metabolism in BB rats with long-term diabetes: decreased turn-over and osteoporosis. Diabetes 39:477–482PubMedGoogle Scholar
  27. 27.
    Mathiassen B, Nielsen S, Ditsel J, Rodbro P (1990) Long-term bone loss in insulin-dependent diabetes mellitus. J Intern Med 227:325–327PubMedCrossRefGoogle Scholar
  28. 28.
    Ortego-Centeno N, Muñoz-Torres M, Hernandez-Quero J, Jurado-Duce A, de la Higuera Torres-Puchol J (1994) Bone mineral density, sex steroids, and mineral metabolism in premenopausal smokers. Calcif Tissue Int 55:403–407PubMedCrossRefGoogle Scholar
  29. 29.
    Pietschmann P, Shernthener G, Woloszcuk W (1988) Serum osteocalcin levels in diabetes mellitus: analysis of the type of diabetes and microvascular complications. Diabetologia 31: 892–895PubMedCrossRefGoogle Scholar
  30. 30.
    Goodman WG, Hori MT (1984) Diminished bone formation in experimental diabetes. Relationship to osteoid maturation and mineralization. Diabetes 33:825–831PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc 1996

Authors and Affiliations

  • M. Muñoz-Torres
    • 1
  • E. Jódar
    • 1
  • F. Escobar-Jiménez
    • 1
  • P. J. López-Ibarra
    • 1
  • J. D. Luna
    • 2
  1. 1.Endocrine Division (Cátedra Medicina Interna I)University HospitalGranadaSpain
  2. 2.Statistics DepartmentUniversity of GranadaGranadaSpain

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