Clin Osteol 2017; 22(4): 128-135

Bone mineral density changes in patients with diabetes mellitus -are the measurements sufficient to assess at-risk patients?Original contributions

P. Jackuliak, M. Kužma, P. Juraj

Introduction: Osteoporosis is an increasingly widespread disease, and so is diabetes mellitus. It is now accepted that osteoporotic fractures are a serious co-morbidity and complication of diabetes. The risk of fracture is elevated in patients with type 1 diabetes (T1DM) in whom bone mineral density (BMD) is reduced as well as in type 2 diabetes (T2DM) patients with normal bone mineral density.

Objective: To determine BMD changes in patients with T1DM and T2DM, and to compare them with a control group without diabetes.

Patients and methods: A cohort of postmenopausal women with diabetes and a matched control group were analyzed. The cohort consisted of 145 women, of whom 76 had diabetes mellitus (25 T1DM, 51 T2DM) and 69 had no glucose metabolism impairment. For all patients, central BMD (lumbar spine [LS] and hip) was tested by DXA, glycemic control parameters were assessed, and anthropometric parameters were measured. Bone quality was analyzed using the TBS software and the results were statistically processed.

Results: In T1DM, BMD was significantly (p = 0.01) lower than in the control group (LS: 0.71 ? 0.13 g/cm2 vs. 0.98 ? 0.13 g/cm2; hip: 0.61 ? 0.10 g/cm2 vs. 0.81 ? 0.13 g/cm2). Patients with T2DM had a higher BMD than patients with T1DM (LS: 0.91 ? 0.16 g/cm2 vs. 0.71 ? 0.13 g/cm2; hip: 0.79 ? 0.17 g/cm2 vs. 0.61 ? 0.13 g/cm2). There was no significant difference in BMD between T2DM patients and controls. Patients with T1DM had a higher incidence of osteoporosis than T2DM patients (35 % vs. 11 %). Up to 76 % of T2DM patients had osteopenia. In the control group, as many as 65 % of patients had neither osteoporosis nor osteopenia, 32 % had osteopenia and 3 % had osteoporosis.

Conclusion: Postmenopausal women with T1DM were confirmed to have significantly reduced BMD compared to controls. Patients with T2DM had higher BMD than T1DM in whom the levels were comparable to those in the non-diabetic population. This fact makes identification of T2DM patients at risk for osteoporotic fractures difficult. Therefore, other modalities are discussed in clinical practice that would improve assessment of the risk for osteoporosis in T2DM. One of them is a combination of densitometry and trabecular bone score.

Keywords: osteoporosis, diabetes mellitus, fractures, bone quality, glycemic compensation

Published: December 11, 2017  Show citation