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Randomized Controlled Trial
. 2014 Apr 11:14:33.
doi: 10.1186/1472-6823-14-33.

Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus

Gudrun Leidig-Bruckner  1 , Sonja Grobholz, Thomas Bruckner, Christa Scheidt-Nave, Peter Nawroth, Jochen G Schneider
Affiliations
Randomized Controlled Trial

Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus

Gudrun Leidig-Bruckner et al. BMC Endocr Disord. .

Abstract

Background: Increased risk of osteoporosis and its clinical significance in patients with diabetes is controversial. We analyze osteoporosis prevalence and determinants of bone mineral density (BMD) in patients with type 1 and 2 diabetes.

Methods: Three hundred and ninety-eight consecutive diabetic patients from a single outpatient clinic received a standardized questionnaire on osteoporosis risk factors, and were evaluated for diabetes-related complications, HbA1c levels, and lumbar spine (LS) and femoral neck (FN) BMD. Of these, 139 (71 men, 68 women) type 1 and 243 (115 men, 128 women) type 2 diabetes patients were included in the study. BMD (T-scores and values adjusted for age, BMI and duration of disease) was compared between patient groups and between patients with type 2 diabetes and population-based controls (255 men, 249 women).

Results: For both genders, adjusted BMD was not different between the type 1 and type 2 diabetes groups but was higher in the type 2 group compared with controls (p < 0.0001). Osteoporosis prevalence (BMD T-score < -2.5 SD) at FN and LS was equivalent in the type 1 and type 2 diabetes groups, but lower in type 2 patients compared with controls (FN: 13.0% vs 21.2%, LS: 6.1% vs 14.9% men; FN: 21.9% vs 32.1%, LS: 9.4% vs 26.9% women). Osteoporosis prevalence was higher at FN-BMD than at LS-BMD. BMD was positively correlated with BMI and negatively correlated with age, but not correlated with diabetes-specific parameters (therapy, HbBA1c, micro- and macrovascular complications) in all subgroups. Fragility fracture prevalence was low (5.2%) and not different between diabetes groups. Fracture patients had lower BMDs compared with those without fractures; however, BMD T-score was above -2.5 SD in most patients.

Conclusions: Diabetes-specific parameters did not predict BMD. Fracture occurrence was similar in both diabetes groups and related to lower BMD, but seems unrelated to the threshold T-score, <-2.5 SD. These results suggest that osteoporosis, and related fractures, is a clinically significant and commonly underestimated problem in diabetes patients.

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Figures

Figure 1
Figure 1
Distribution of age at time of diagnosis of diabetes subgrouped by type 1 and type 2 diabetes (A) and distribution of age at time of study performance (B).
Figure 2
Figure 2
Distribution of femoral neck bone mineral density (BMD) subgrouped according to type of diabetes and gender in comparison to the normal distribution (Hologic reference population, mean ± 2 SD).
Figure 3
Figure 3
Distribution of bone mineral density (BMD) (Box-plots) in patients with and without insufficiency fractures subgrouped by type of diabetes mellitus; T-score femoral neck BMD (upper part), T-score lumbar spine BMD (lower part).
See this image and copyright information in PMC

References

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