Abstract
Posttransplant osteoporosis, which evolves from preexisting bone pathologies, represents a serious complication with deteriorating consequences. The aim of our study was to evaluate epidemiological data on bone mineral density (BMD) in subjects with type 1 diabetes (T1DM) in advanced stages of diabetic nephropathy indicated for simultaneous pancreas-kidney transplantation (SPK). We retrospectively compiled biochemical and densitometrical data from 177 patients with T1DM at CKD (chronic kidney disease) stages G4-G5 (115 men, 62 women, median age 40 yr, diabetes duration 23 yr) enrolled on waiting list for SPK for the first time between the years 2011 and 2016. Median Z-scores were as follows: lumbar spine (LS): -0.8 [interquartile range -1.75 to 0.1]; total hip (TH): -1.2 [-1.75 to -0.6]; femoral neck (FN): -1.2 [-1.9 to -0.7]; and distal radius (DR): -0.8 [-1.4 to -0.1]. We noted a gender difference in LS, with worse results for men (-1.1 vs. -0.3) even after adjusting for BMI (body mass index) and glomerular filtration (p < 0.001). Osteoporotic and osteopenic ranges (based on T-scores) for all major sites were 27.7% and 56.5%, respectively, with similar results across both genders. Women had a significantly higher proportion of normal BMD in LS than men (67.7 vs. 49.4%, p < 0.05). Patients with T1DM at CKD stages G4-G5 exhibited serious BMD impairment despite their young age. Men surprisingly displayed lower Z-scores and higher percentages of pathological BMD values in LS than women did. The introduction of adequate preventive measures during the advanced stages of diabetic nephropathy to prevent bone loss is recommended.
Highlights
Type 1 diabetes is an autoimmune disease with lifelong insulin dependence, and despite the fact that great progress has been made in implementing modern ways of treatment into the everyday glucose management, patients still face the risk of glucose excursions with consequent development of late complications
All tissues and organs may be targeted by diabetes, and besides the major well-known microvascular and macrovascular complications, type 1 diabetes mellitus is associated with low bone mineral density (BMD) and increased risk of fracture [1]
In cases where combined with chronic kidney diseaseassociated metabolic bone disease (CKD-MBD) serious bone loss follows as documented in our study with 27.7% of subjects categorised as having osteoporosis in any major site
Summary
Type 1 diabetes is an autoimmune disease with lifelong insulin dependence, and despite the fact that great progress has been made in implementing modern ways of treatment (insulin analogues, continuous subcutaneous insulin infusions, and continuous glucose monitoring systems) into the everyday glucose management, patients still face the risk of glucose excursions with consequent development of late complications. All tissues and organs may be targeted by diabetes, and besides the major well-known microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (atherosclerosis) complications, type 1 diabetes mellitus is associated with low bone mineral density (BMD) and increased risk of fracture [1]. Diabetic nephropathy affects approximately one-third of subjects with diabetes and can eventually progress to end-stage renal disease (ESRD) requiring renal replacement therapy. In cases where unprevented chronic kidney diseaseassociated metabolic bone disease (CKD-MBD) is Journal of Diabetes Research established, subjects with preceding diabetic osteopathy are at extreme risk of developing profound bone loss
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