Type 1 diabetes mellitus (T1DM) has been inconsistently associated with low bone mineral density (BMD) and increased fracture risk. 86 consecutive T1DM cases and 140 unrelated age and sex matched healthy nondiabetic controls were included in the study. After history and examination, BMD and body composition were assessed by dual energy X-ray absorptiometry (DXA). Serum samples were analyzed for calcium, phosphorus, albumin, creatinine, alkaline phosphatase, 25 (OH) vitamin D3, intact parathormone (PTH) levels (both cases and controls) and HbA1c, antimicrosomal and IgA tissue transglutaminase (IgA TTG) antibodies, cortisol, follicle stimulating hormone (FSH), testosterone, sex hormone binding globulin (SHBG), tetraiodothyronine (T4), thyroid stimulating hormone (TSH), growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein 3 (IGFBP3) (cases only). T1DM cases had a lower BMD as compared to controls at both total body (TB) and lumbar spine (LS) ( ). Patients with celiac autoimmunity (CA) had significantly, lower BMD as compared to age, sex, and body mass index (BMI) matched T1DM controls. Linear regression analysis showed that low BMD in T1DM patients was associated with poor glycaemic control, lower IGF-1 levels, less physical activity (in total population as well as in male and female subgroups), and lower body fat percentage (in females) and higher alkaline phosphatase level (in males) ( ). 1. Introduction T1DM has been variably associated with the risk of poor BMD [1–3]. The more consistent is a definite increase in fracture risk [1, 2]. There is a relative paucity of data regarding bone health in T1DM as compared to other complications, and to the best of our knowledge, no Indian data is published till date. Apart from poor glycaemic control, associated immunological disorders and loss of other bone anabolic peptides may also adversely affect bone health [1, 3]. Identifying factors affecting bone health in T1DM can help in improving bone health. Possible factors implicated in poor bone health and increased fracture risk in T1DM are enumerated in Table 1. Table 1: Factors implicated in poor bone health and increased fracture risk in T1DM. The objective of this study was to evaluate the difference in BMD amongst T1DM subjects and age, sex, and BMI matched controls and also to determine the various factors that might adversely impact BMD in T1DM subjects. 2. Methods The study was conducted at a large tertiary care centre hospital run by the Municipal Corporation in Mumbai, India (latitude 18°55′N
References
[1]
P. Vestergaard, “Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis,” Osteoporosis International, vol. 18, no. 4, pp. 427–444, 2007.
[2]
M. Janghorbani, R. M. van Dam, W. C. Willett, and F. B. Hu, “Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture,” American Journal of Epidemiology, vol. 166, no. 5, pp. 495–505, 2007.
[3]
E. Strotmeyer and J. Cauler, “Diabetes mellitus, bone mineral density, and fracture risk,” Current Opinion in Endocrinology, Diabetes and Obesity, vol. 14, no. 6, pp. 429–435, 2007.
[4]
M. Hagstromer, P. Oja, and M. Sjostrom, “The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity,” Public Health Nutrition, vol. 9, no. 6, pp. 755–762, 2006.
[5]
J. T. Warner, F. J. Cowan, F. D. J. Dunstan, W. D. Evans, D. K. H. Webb, and J. W. Gregory, “Measured and predicted bone mineral content in healthy boys and girls aged 6–18 years: adjustment for body size and puberty,” Acta Paediatrica, vol. 87, no. 3, pp. 244–249, 1998.
[6]
J. Léger, D. Marinovic, C. Alberti et al., “Lower bone mineral content in children with type 1 diabetes mellitus is linked to female sex, low insulin-like growth factor type I levels, and high insulin requirement,” Journal of Clinical Endocrinology and Metabolism, vol. 91, no. 10, pp. 3947–3953, 2006.
[7]
M. T. Saha, H. Sievanen, M. K. Salo, S. Tulokas, and H. H. Saha, “Bone mass and structure in adolescents with type 1 diabetes compared to healthy peers,” Osteoporosis International, vol. 20, no. 8, pp. 1401–1406, 2009.
[8]
L. D. Mastrandrea, J. Wende, R. P. Donahue, K. M. Hovey, A. Clark, and T. Quattrin, “Young women with type 1 diabetes have lower bone mineral density that persists over time,” Diabetes Care, vol. 31, no. 9, pp. 1729–1735, 2008.
[9]
P. Campos, P. Lopez, F. Escobar, M. D. Serenno-Pardo, and A. G. Garcia-Serviquon, “Intensive insulin therapy and bone mineral density in type 1 diabetes mellitus: a prospective study,” Osteoporosis International, vol. 11, no. 5, pp. 455–459, 2000.
[10]
V. Rakic, W. A. Davis, S. A. P. Chubb, F. M. A. Islam, R. L. Prince, and T. M. E. Davis, “Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study,” Diabetologia, vol. 49, no. 5, pp. 863–871, 2006.
[11]
P. M. Jehle, D. R. Jehle, S. Mohan, and B. O. Bohm, “Serum levels of insulin-like growth factor system components and relationship to bone metabolism in type 1 and type 2 diabetes mellitus patients,” Journal of Endocrinology, vol. 159, no. 2, pp. 297–306, 1998.
[12]
E. Gazzerro and E. Canalis, “Skeletal actions of insulin-like growth factors,” Expert Review of Endocrinology and Metabolism, vol. 1, no. 1, pp. 47–56, 2006.
[13]
M. Nihlsson, C. Ohlsson, A. Odel, D. Melstrom, and M. Lorentzom, “Increased physical activity is associated with enhanced development of peak bone mass in men: a five-year longitudinal study,” Journal of Bone and Mineral Research, vol. 27, no. 5, pp. 1206–1214, 2012.
[14]
P. Eskildsen, H. Andreassen, and M. Rix, “Impact of peripheral neuropathy on bone density in patients with type 1 diabetes,” Diabetes Care, vol. 22, no. 5, pp. 827–831, 1999.
[15]
G. T. K. Holmes, “Celiac disease and type 1 diabetes-the case for screening,” Diabetic Medicine, vol. 87, no. 6, pp. 495–498, 2002.
[16]
S. Sud, M. Marcon, E. Essar, M. R. Palmert, D. Daneman, and F. H. Mahmud, “Celiac disease and pediatric type 1 diabetes: diagnostic and treatment dilemmas,” International Journal of Pediatric Endocrinology, vol. 2010, Article ID 161285, 2010.
[17]
J. H. Simmons, G. J. Klingensmith, K. McFann et al., “Impact of celiac autoimmunity on children with type 1 diabetes,” Journal of Pediatrics, vol. 150, no. 5, pp. 461–466, 2007.
[18]
K. K. Danielson, M. E. Elliott, T. Lecaire, N. Binkley, and M. Palta, “Poor glycemic control is associated with low BMD detected in premenopausal women with type 1 diabetes,” Osteoporosis International, vol. 20, no. 6, pp. 923–933, 2009.
