Prevalence and risk factors for osteoporosis in type 1 diabetes-results from an observational study.

Abstract

The prevalence of osteoporosis in individuals with type 1 diabetes (T1D) was investigated. Based on IOF/ADA recommendations, 36% had indications for anti-osteoporotic therapy. We propose that postmenopausal women and men with T1D and age > 50 years are screened for osteoporosis.

Purpose: Type 1 diabetes is associated with an increased fracture risk and a lowering of the threshold for osteoporosis treatment has been recommended to be increased from a bone mineral density of a T-score ≤ - 2.5 to a T-score ≤ - 2.0. In this study, we aimed to investigate the prevalence and risk factors for osteoporosis in type 1 diabetes using the classic diagnostic criteria defined by WHO and the novel T-score cutoff of - 2.0 proposed by the ADA.

Methods: In a cross-sectional study, data were collected from the type 1 diabetes clinic at Steno Diabetes Center Aarhus, Aarhus University Hospital, where active attenders in the clinic were offered screening for osteoporosis using DXA of the lumbar spine and hip in the time period 2020-2022.

Results: A total of 764 individuals with type 1 diabetes had a DXA and of these, 25.5% had osteoporosis based on a vertebral fracture or T-score ≤ - 2.5, and 36% met ADA-treatment criteria with a vertebral fracture or T-score ≤ - 2.0. In multivariate analysis increasing age (OR = 1.3, 95% CI 1.0; 1.7) and a family history of osteoporosis (OR = 1.9, 95% CI 1.2; 3.0) were associated with an increased risk of osteoporosis, whereas an increase in BMI was associated with a decreased risk of osteoporosis (OR = 0.87, 95% CI 0.82; 0.92).

Conclusion: The present study finds that a high proportion of individuals with type 1 diabetes have osteoporosis, and an even higher proportion meet the treatment criteria proposed by the ADA, and thus, early detection and treatment of osteoporosis may reduce the apparent increased fracture risk in type 1 diabetes.