Abstract
Summary
Diabetes mellitus is associated with a higher risk of fracture. In this study, we analysed the bone quality of premenopausal women with type 1 diabetes mellitus by microindentation. No differences in bone quality were identified between patients and healthy controls, suggesting that intensive insulin therapy can preserve bone health.
Purpose
To compare the bone quality of women with type 1 diabetes mellitus (T1DM) and healthy controls, and to determine the relationship with bone mineral density (BMD).
Methods
This was a cross-sectional study of 45 premenopausal women with T1DM and 21 healthy controls, matched according to age and BMI. Clinical parameters, BMD and bone tissue mechanical properties (assessed using the bone material strength index [BMSi]) were evaluated in each group using microindentation. In T1DM patients, glycosylated haemoglobin (HbA1c), the number of hypoglycaemic events and the status of chronic complications were also analysed.
Results
No differences in BMSi or BMD between T1DM patients and healthy controls were identified. In the T1DM patients, the mean HbA1c was 7.52% ± 1.00% and the mean time elapsed since diagnosis was 22.6 ± 12.2 years. Eight patients (17.7%) met the criteria for metabolic syndrome (MetS), and microvascular complications were present in 12 patients (26.7%). Neither the number of features of MetS present nor the presence of microangiopathy was found to be associated with BMSi.
Conclusions
T1DM premenopausal patients showed bone tissue properties comparable to those shown by controls. Further larger-scale studies should be conducted to confirm these results.
Similar content being viewed by others
References
Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes - a meta-analysis. Osteoporos Int 18:427–444. https://doi.org/10.1007/s00198-006-0253-4
Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505. https://doi.org/10.1093/aje/kwm106
Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the nurses’ health study. Diabetes Care 29:1573–1578. https://doi.org/10.2337/dc06-0440
Weber DR, Schwartz G (2016) Epidemiology of skeletal health in type 1 diabetes. Curr Osteoporos Rep 14:327–336. https://doi.org/10.1007/s11914-016-0333-0
Yamamoto M, Yamaguchi T, Nawata K, Yamauchi M, Sugimoto T (2012) Decreased PTH levels accompanied by low bone formation are associated with vertebral fractures in postmenopausal women with type 2 diabetes. J Clin Endocrinol Metab 97(4):1277–1284. https://doi.org/10.1210/jc.2011-2537
Gerdhem P, Isaksson A, Akesson K, Obrant KJ (2005) Increased bone density and decreased bone turnover , but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus. Osteoporos Int:1506–1512. https://doi.org/10.1007/s00198-005-1877-5
Hofbauer LC, Brueck CC, Singh SK, Dobnig H (2007) Osteoporosis in patients with diabetes mellitus. J Bone Miner Res 22:1317–1328. https://doi.org/10.1359/jbmr.070510
Heap J, Muray MA, Miller SC, Jalili T, Moyer-Mileur laurie J (2004) Alterations in bone characteristics associated with glycemic ocntrol in adolescents with type 1 diabetes mellitus. J Pediatr 144:56–62
Kennedy RL, Henry J, Chapman AJ, Nayar R, Grant P, Morris AD (2002) Accidents in patients with insulin-treated diabetes: increased risk of low-impact falls but not motor vehicle crashes — a prospective register-based study. J Trauma 52(4):660–666
Farr JN, Drake MT, Amin S, III LJM, McCready LK, Khosla S (2014) In vivo assessment of bone quality in postmenopausal women with type 2 diabetes. J Bone Miner Res 29:784–786. https://doi.org/10.1002/jbmr.2189
Chillarón JJ, Flores-le-roux JA, Goday A, Benaiges D, Carrera MJ (2010) Síndrome metabólico y diabetes mellitus tipo 1: prevalencia y factores relacionados. Rev Esp Cardiol 63(4):423–429
Diez-Perez A, Güerri R, Nogues X, Cáceres E, Peñ MJ, Mellibovsky L et al (2010) Microindentation for in vivo measurement of bone tissue mechanical properties in humans. J Bone Miner Res 25:1877–1885. https://doi.org/10.1002/jbmr.73
Nilsson AG, Sundh D, Johansson L, Nilsson M, Mellström D, Rudäng R et al (2017) Type 2 diabetes mellitus is associated with better bone microarchitecture but lower bone material strength and poorer physical function in elderly women: a population-based study. J Bone Miner Res 32:1062–1071. https://doi.org/10.1002/jbmr.3057
American Diabetes Association (2014) Standards of medical care in diabetes. Diabetes Care 37(Suppl 1):S14–S80. https://doi.org/10.2337/dc14-S014
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: executive summary. Crit Pathw Cardiol 4:198–203. https://doi.org/10.1161/CIRCULATIONAHA.105.169405
Williams KV, Erbey JR, Becker D, Arslanian S, Orchard TJ (2000) Can clinical factors estimate insulin resistance in type 1 diabetes? Diabetes. 49(4):626–632
Diez-Perez A, Bouxsein ML, Eriksen EF, Khosla S, Nyman JS, Papapoulos S et al (2016) Technical note: recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation. Bone Reports 5:181–185. https://doi.org/10.1016/j.bonr.2016.07.004
Hamilton EJ, Drinkwater JJ, Paul Chubb SA, Rakic V, Kamber N, Zhu K et al (2018) A 10-year prospective study of bone mineral density and bone turnover in males and females with type 1 diabetes. J Clin Endocrinol Metab 103:3531–3539. https://doi.org/10.1210/jc.2018-00850
The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study was approved by the “Comitè d'Ètica de la Investigació amb Medicaments” (CEIm; N° 2012/4990/l; 03/04/2013) and was performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from each participant after they were provided with a full explanation of the purpose and nature of all the procedures used.
Conflicts of interest
None.
Authorship and disclosure form
All authors sign and complete the Authorship and Disclosure form.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ballesta, S., Güerri-Fernández, R.C., Chillarón, J.J. et al. The use of microindentation for the study of bone properties in type 1 diabetes mellitus patients. Osteoporos Int 31, 175–180 (2020). https://doi.org/10.1007/s00198-019-05178-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-019-05178-1