Abstract
Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D.
Highlights
Type 1 diabetes (T1D) is an autoimmune disease that precipitates in genetically susceptible individuals by environmental factors
Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low body mass index (BMI), reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density
A major interest has been focused on poor bone metabolism in T1D that can represent an overlooked complication of diabetes
Summary
Type 1 diabetes (T1D) is an autoimmune disease that precipitates in genetically susceptible individuals by environmental factors. Miazgowski et al [29] did not find any differences in hip cross-section area between T1D adult males and healthy controls, in the presence, at the same time, of low BMD Such discrepancy could be explained by the fact that reduced bone size in the phase of growing can normalize with age, as shown in a 5-year followup study by Bechtold et al [39]. There is strong evidence that bones in T1D patients are characterized by poor mineralization and smaller and thinner size with reduced bone strength and quality, which can lead to a higher fracture incidence at any site, predominantly at femoral neck. Why and How Did It Happen? Pathophysiological Aspects of Bone Disorder in Type 1 Diabetes
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