How Does Type 1 Diabetes Impact Fracture Risk?

Although type 1 diabetes and diabetic neuropathy have an impact on bone structure, these effects are not enough to explain the increased fracture risk seen in patients within this population, according to a recent study.

For their study, the researchers compared areal bone mineral density (aBMD) and appendicular muscle mass, microarchitecture, bone turnover markers, muscle strength, gait, and balance among patients with type 1 diabetes with (n = 20) and without (n = 20) distal symmetric sensorimotor polyneuropathy and controls (n = 20).

Overall, the researchers observed that C-terminal cross-linked telopeptide and N-terminal propeptide of type I procollagen were lower among those participants with type 1 diabetes compared with controls, and those with neuropathy had worse performance as measured by the Short Physical Performance Battery than those without neuropathy and controls.

They also found that tibial cortical porosity was 56% higher in patients with type 1 diabetes and neuropathy compared with those without neuropathy. This had a positive correlation with severity of neuropathy and a negative correlation with nerve conduction amplitude and velocity. Higher bone mineral density and bone volume were also observed in those without neuropathy compared with controls.

“Our findings suggest that bone structure does not fully explain the rate of fractures in type 1 diabetes. We conclude that the increase in the risk of fractures in type 1 diabetes is multifactorial with both skeletal and non‐skeletal contributions,” they concluded.

—Michael Potts

Reference:

Vilaca T, Paggiosi M, Walsh JS, et al. The Effects of type 1 diabetes and diabetic peripheral neuropathy on the musculoskeletal system: a case–control study. Published online April 6, 2021. JBMR. Doi:10.1002/jbmr.4271