Epidemiology of Skeletal Health in Type 1 Diabetes

Abstract

The skeleton is adversely affected by type 1 diabetes (T1D). Patients with T1D of both sexes have an increased risk of fracture that begins in childhood and extends across the entire lifespan. T1D is characterized by mild to modest deficits in bone density, structure, and microarchitecture. Current evidence suggests that the observed bone deficits in T1D are the result of impaired bone formation rather than increased bone resorption. There is emerging data that bone quality is impaired in T1D, which may explain the findings that fracture risk is elevated out of proportion to the degree of bone mineral deficit. In this review, we summarize the current knowledge regarding the epidemiology of skeletal health in T1D. Given the high individual and societal burden of osteoporotic fracture, there is an urgent need to better understand the etiology of T1D-related bone disease so that clinical strategies to prevent fracture can be developed.

Keywords: Bone mineral density; Epidemiology; Fracture; Osteoporosis; Type 1 diabetes.

Fig. 1

Fracture risk is increased in T1D across the lifespan. Crude hazard ratios are shown for incident fracture (all sites) in 30,394 T1D participants compared to 303,872 participants without diabetes. Reprinted with permission from The American Diabetes Association. “Copyright ©2015 American Diabetes Association. From: Diabetes Care 2015 Oct. 38(10): 1913–1920