bone mineral density in type 1 diabetes mellitus
Bone mineral density of patients suffering from type 1 diabetes mellitus is often reduced due to impaired insulin secretion. However, it is unclear whether the rate of bone mineral density reduction is affected by the type 1 diabetes mellitus subtype. The objective of this study is to understand the difference in bone mineral density across type 1 diabetes mellitus subtypes: slowly progressive (SP), acute-onset (AO), and fulminant (F).
Bone Mineral Density of Type 1 Diabetes Mellitus Patients
Type 1 diabetes mellitus patients have decreased bone mineral density in both the lumbar spine and the femoral neck. Therefore, a higher fracture risk has been implicated in type 1 diabetes mellitus, particularly in older adult populations and postmenopausal women compared with the general population. Bone mineral density screening is critical for these patients at the onset or suspected onset of disease.
Type 1 diabetes mellitus is a disease often caused by the destruction of pancreatic beta cells, which leads to insulin deficiency, and requires lifelong exogenous insulin replacement therapy. According to the diagnostic criteria of the Japan Diabetes Society, three pathogenic definitions of type 1 diabetes mellitus have been demonstrated: slowly progressive (SP), acute-onset (AO), and fulminant (F).
In patients with acute-onset and fulminant type 1 diabetes mellitus, lifelong insulin treatment initiation is required soon after the diagnosis because of the marked acute progression of insulin deficiency. As the decline in endogenous insulin secretion occurs differently in each subtype, the differences in bone mineral density between the subtypes could be a suitable model to represent the effect of the duration of low insulin exposure on bone mineral density.
The study is a retrospective, single-center, cross-sectional study conducted at Kobe University Hospital. A total of 170 Japanese adult patients with type 1 diabetes mellitus admitted to the unit for evaluation of diabetic complications between January 2008 and April 2019 and who underwent bone mineral density measurements were enrolled in this study.
A total of 18 patients were excluded based on the following criteria: estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m2; disease duration of <1 year; and medical history of osteoporosis, including treatment with bisphosphonates, selective estrogen receptor modulators, denosumab, and recombinant human parathyroid hormone.
The scientific study was conducted retrospectively, and all procedures were part of routine medical care. The patients had the option of an opt-out process, where patients were provided with information explaining the data to be collected and the purpose of the study and were given the opportunity to withdraw.
Biochemical measurements, Other Covariates, and Bone Mineral Density
Anthropometric parameters such as body mass index (BMI) were collected for each patient along with biochemical data, including platelets, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, cholinesterase, thyroid-stimulating hormone (TSH), free thyroxine (FT4), Ca (correction value), phosphate (P), insulin-like growth factor I (IGF-I), and hemoglobin A1c (HbA1c).
The onset of type 1 diabetes mellitus, disease duration, and a previous history of cardiovascular diseases was determined by medical review. Evaluation of diabetic neuropathy was based on symptoms, quantitative sensory testing (vibration and monofilament test), and quantitative motor testing (patellar and ankle reflexes)18.
The bone mineral density of the lumbar spine (L2–L4) and the femoral neck was measured using dual-energy x-ray absorptiometry (DXA; Horizon A DXA System) simultaneously with blood sampling.
The lumbar spine BMD-Z was lower in the acute-onset than in the slowly progressive subtype (P = 0.03). No differences were observed when compared with the fulminant subtype. The femoral neck BMD-Z tended to be higher in the slowly progressive than in the acute-onset and fulminant subtypes. Multiple regression analyses showed that the lumbar spine BMD-Z was associated with subtypes (AO vs SP) (P = 0.01), but not subtypes (F vs SP), adjusted for sex, duration, retinopathy, and C-peptide immunoreactivity (CPR).
When the patients were divided into disease duration tertiles, in the first and second tertiles, the CPR levels were lower in the acute-onset or fulminant than in the slowly progressive subtype. In contrast, the lumbar spine and femoral neck BMD-Z differed between the acute-onset and slowly progressive only in the second tertiles (both P < 0.01), with a similar tendency between the fulminant and slowly progressive subtypes.
The lower bone mineral density levels in the present type 1 diabetes mellitus participants were consistent with those reported in a previous meta-analysis among other races, indicating that race-based differences in bone metabolism are not significant. This finding also suggests that these participants were suitable for further investigations as a model of bone research in type 1 diabetes mellitus.
The bone mineral density lowering rates were strongly associated with type 1 diabetes mellitus subtypes, indicating that the rate of endogenous insulin decline may be an important determinant of bone mineral density reduction in this disease. This is also the largest study involving adult Japanese patients with type 1 diabetes mellitus, showing that bone mineral density in those with type 1 diabetes mellitus is lower than that in a similarly aged healthy population.
A low bone mineral density in type 1 diabetes mellitus is associated with endogenous insulin deficiency, as well as low BMI and diabetic complications. In this study, the disease duration, BMI, and microvascular disease did not differ across the three subtypes, except for diabetic retinopathy. Regarding macrovascular disease, the previous history of cardiovascular disease did not differ across the subtypes, suggesting that these subtypes were suitable for analyzing the relationship between endogenous insulin secretion and bone mineral density in type 1 diabetes mellitus.
Among the type 1 diabetes mellitus subtypes, bone mineral density undergoes time-dependent changes, which reveals that the bone mineral density decline follows the impaired insulin secretion. These results provide novel insights into the association between the low insulin exposure duration and bone mineral density.
To conclude, this is the first study to observe the variation in the lowering of bone mineral density between the type 1 diabetes mellitus subtypes, acute-onset, slowly progressive, and fulminant, and demonstrates that bone mineral density in the acute-onset group was lower than that in the slowly progressive group.
Since these subtypes have different time courses for insulin dependence, the analysis of bone mineral density across the groups appears to be an excellent model for demonstrating the pathophysiological association between impaired endogenous insulin secretion and reduced bone mineral density in this beta-cell dysfunction disorder.
Further longitudinal prospective studies are needed to clarify these important clinical pathologies.
Oncology Related Tools
- Prognostic Scoring for Myelofibrosis
- Opioid Conversion Calculator
- Updated Advanced Opioid Conversion Calculator
- Nonsteroidal anti-inflammatory drugs (NSAID) Selection Tool
- Absolute Neutrophil Count Calculator
- Body Surface Area (BSA) Multi-Calc
- Carboplatin AUC Calculator
- Carboplatin AUC – Updated Version
- Urinary Indices, Renal Failure Index (RFI) and Fractional Excretion of Sodium (FE-NA)
- Creatinine Clearance (CRCL) – Standard Calculator
- Creatinine Clearance Multi-Calc – All of the latest research
- Patient Controlled Analgesia (PCA) Settings
- Intravenous Antineoplastic Agents – Administration Guidelines
- Therapeutic Drug Levels
- Beers Criteria for potentially inappropriate medications
- Allergic response? 12-step desensitization protocol
- Protein requirements calculator
- Basal Metabolic Rate (BMR) Multi-calc (Estimate caloric requirements)
- Irritable Bowel Syndrome Treatment Options
- Common Anti-emetics
- Fall Assessment – Berg Balance Scale
- Cochlear Implants and Vestibular Screening
- Aprocitentan In Resistant Hypertension
- Predicting Cardiovascular Disease With Body Mass Index
- Obesity Screening To Predict Hot Flashes
- Hypertension Screening For Cardiovascular Health
- Dental Screening For Cardiovascular Disease Risk
- Blood Pressure and CVD Risk Reduction
- Lifestyle Changes For Hypoglycemia Prevention
- Ovarian Adenocarcinoma With Glaucoma: A Case Report
- Community Hypertension and Atherosclerosis Risk
- Thyroid Malignancy and Serum Calcitonin
- Rare Schwannoma In Lateral Nasal Wall
- Pyrotinib Therapy In HER2+ Breast Cancer
- Osteopenia Predicts Outcomes in Pancreatic Cancer
- Outcomes of Physical Exercise Regimens in Advanced Cancer
- Penile Squamous Cell Carcinoma And HPV
- Radiation Therapy And VTE Risk
- Pseudouveitis With Pancreatic Carcinoma: A Case Study
- Cancer Prevention In Rural Communities
- Skeletal Muscle Mass and Cancer Patient Quality of Life: A Meta-Analysis
- Incidence of Secondary Cancers After CIRT VS RT
- Filanesib Combination Therapy in Multiple Myeloma
- Pediatric Leukemia Patients Utilizing Levofloxacin
- Breast Cancer And An Analysis Of Cardiovascular Events
- Monotherapy Or Chemotherapy Adjunct: Pembrolizumab in Advanced NSCLC
- Advanced Gastric Cancer: Prognosis with Nivolumab Monotherapy
- Sinonasal B‐Cell Lymphomas A Cohort Study On Progression And Recurrence
- Platinum Resistant Recurrent Ovarian Cancer Treatment+/-Bevacizumab
- Metastatic Melanoma and Follow-Up MRI Scans
- Isatuximab Treatment in Refractory T-Acute Lymphoblastic Leukemia
- Ocular Melanoma and Treatment with Metformin
- Gastric Neuroendocrine Neoplasms
- Lung Cancer with Brain Metastasis After Late-Onset Bipolar Disorder: A Case Report
- Anlotinib with Camrelizumab in Lung Cancer Treatment
- Sebaceous Carcinoma Treatment Outcomes: A Multicenter Study
- Diffuse-Type Tenosynovial Giant Cell Tumors: Treatment and Progression
- Lung Spindle Cell Carcinoma Responsive to Pembrolizumab: A Rare Case Report
- DNA Methylation Profiling in Sarcoma Classification
- Breast Tomosynthesis Simulator For Virtual Clinical Trials
- Renal Cell Carcinoma-Prognosis Via Albumin Levels
- Diagnostic Error Causing Cases of Cytopenia
- Hodgkin’s Lymphoma: A Case Study With Nystagmus and Diplopia
- Brugada Syndrome Treated with Lenalidomide: A Case Study
- Koolen-de Vries Case Study
- Suicidal Ideation and Somatic Treatments
- Study on Pavlovian Fear Conditioning and Fear Reversal in OCD
- Anxiety Scales in Lewy Body Disease
- Inoperable Locally Advanced Non-Small Cell Lung Cancer: Survival Rates of Endostar, CCRT
- Physician Practice Management and Private Equity
- Physician Spending And Its Association With Patient Outcomes
- Physician Burnout: Causes and Prevention
- LEAP-MS: Adaptations for Advanced Stages
- MS: Exercise Impacts on MRI
- The Role of Preretirement Job Complexity in Cognitive Performance
- Extrapontine Myelinolysis and PTA in Pregnancy
- Verbal Communication and Masks
- Sugammadex Versus Neostigmine in Thyroidectomy
- SGLT Inhibitors on Weight and Lipid Metabolism in Diabetes
- Saxagliptin: Obese Patients with Impaired Glucose Tolerance
- Levothyroxine Therapy and Depression
- Grave’s Disease and Risk of Systemic Lupus Erythematosus
- Benign Thyroid Removal and Patient Satisfaction
- MF- Biology, Management, and a Case Study of Ocular Manifestation
- Quality Of Life In Adolescent Cancer Survivors
- Cancer Opioid Risk Score
- Oncology-Specific Opioid Risk Calculator In Cancer Survivors
- 3D MRI for Non-invasive Ocular Proton Therapy of Uveal Melanomas
- Sexual Dysfunction in Prostate Cancer Patients
- 3-Day Surprise Question To Predict Survival Rates in Advanced Cancer Patients