Assessment of the risk of osteoporotic vertebral fractures of the 2nd and 3rd degree in women in reproductive age and men under 50 with type 1 diabetes mellitus

Abstract

Rationale : Patients with type 1 diabetes mellitus (DM1) have higher rates of any fractures than those without diabetes. Aim : To identify significant predictors of the osteoporotic vertebral fractures of the 2nd and 3rd degrees and to develop a statistical model for the risk assessment in DM1 patients. Materials and methods : 97 DM1 patients and 77 control aged below 50 participated in this cross-sectional study. Multiple logistic regressions were used to assess the risk of osteoporotic vertebral fractures of the 2nd and 3rd degrees in DM1 patients. Results : Patients with DM1 had a statistically significantly lower bone mineral density (BMD) (Z-criterion) in all areas of the axial skeleton, compared to that in the control group (p< 0.001). Osteoporotic vertebral fractures were significantly more frequent (p=0.0385) in DM1 patients than in the controls. The subgroup of DM1 patients with osteoporotic vertebral fractures (n=8) had higher daily insulin requirement per kg of bodyweight compared to that in the subgroup of the patients without fractures (n=89; р=0.029), as well as lower axial BMD (Z-criterion L1–L4, p=0.002; femoral neck Z-criterion, p< 0.001; proximal femoral Z-criterion, p=0.002). We developed a statistical regression equation model including two parameters: 1) presence or absence of low femoral neck BMD based on the dual X-ray absorptiometry, 2) daily insulin requirement per kg of bodyweight. Conclusion : The statistical model has the sensitivity of 87% and specificity of 75% to predict that the DM1 patients would have low or high risk of osteoporotic vertebral fractures of the 2nd and 3rd degree.