Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus
1 Practice for Endocrinology and Nuclear Medicine, Brückenstraße 21, Heidelberg 69120, Germany
2 Department of Internal Medicine, Endocrinology and Metabolism, University of Heidelberg, INF 410, Heidelberg 69120, Germany
3 Institute for Medical Biometry and Informatics, University of Heidelberg, INF 305, Heidelberg 69120, Germany
4 Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Straße 62-66, Berlin 12101, Germany
5 Luxembourg Centre for Systems Biomedicine (LCSB), Université du Luxembourg & Internal Medicine II, Saarland University Medical Center at Homburg/Saar, Kirrbergerstrasse 100, Homburg/Saar 66421, Germany
BMC Endocrine Disorders 2014, 14:33 doi:10.1186/1472-6823-14-33Published: 11 April 2014
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.
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).
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.
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.