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Bone Structure and Predictors of Fracture in Type 1 and Type 2 Diabetes
Jakob Starup-Linde1, Simon Lykkeboe1, Søren Gregersen1
1Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
Context:
Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture.
Objective:
The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations.
Design:
This was a cross-sectional study.
Setting And Patients:
Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study.
Main Outcome Measures:
Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Blood samples were collected for bone turnover markers. Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray, and incident fractures were collected from The Danish National Hospital Discharge Register.
Results:
Bone mineral density (BMD) was higher in type 2 than type 1 diabetes patients at the hip, femur, and spine; however, only the hip differed in multivariate-adjusted models. Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models. Sclerostin levels were inversely associated with fracture in type 1 diabetes patients. The patients with the highest tertile of sclerostin had an 81% decreased risk of a fracture compared with the lowest tertile.
Conclusions:
Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia. Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance. Studies with longer follow-up are needed.
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