Diabetic neuropathy tied with increased nonvertebral fracture risk, in long-standing T1DM

Type 1 diabetes (T1DM) is associated with increased fracture risk, specifically at nonvertebral sites. The influence of glycemic control and microvascular disease on skeletal health in long-standing T1DM remains largely unknown.

They aimed to assess areal (aBMD) and volumetric bone mineral density (vBMD), bone microarchitecture, bone turnover, and estimated bone strength in patients with long-standing T1DM, defined as disease duration ≥25 years. We recruited 59 patients with T1DM (disease duration 37.7 ± 9.0 years; age 59.9 ± 9.9 years.; body mass index [BMI] 25.5 ± 3.7 kg/m2; 5-year median glycated hemoglobin [HbA1c] 7.1% [IQR 6.82–7.40]) and 77 non-diabetic controls. Dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HRpQCT) at the ultra distal radius and tibia, and biochemical markers of bone turnover were assessed. Group comparisons were performed after adjustment for age, gender, and BMI.

The results are as follows:

Patients with T1DM had lower aBMD at the hip (p < 0.001), distal radius (p = 0.01), lumbar spine (p = 0.04), and femoral neck (p = 0.05) as compared to controls. Cross-linked C-telopeptide (CTX), a marker of bone resorption, was significantly lower in T1DM (p = 0.005). At the distal radius, there were no significant differences in vBMD and bone microarchitecture between both groups. In contrast, patients with T1DM had lower cortical thickness (estimate [95% confidence interval]: −0.14 [−0.24, −0.05], p < 0.01) and lower cortical vBMD (−28.66 [−54.38, −2.93], p = 0.03) at the ultra distal tibia. Bone strength and bone stiffness at the tibia, determined by homogenized finite element modelling, were significantly reduced in T1DM compared to controls. Both the altered cortical microarchitecture and decreased bone strength and stiffness were dependent on the presence of diabetic peripheral neuropathy. In addition to a reduced aBMD and decreased bone resorption, long-standing, well-controlled T1DM is associated with a cortical bone deficit at the ultradistal tibia with reduced bone strength and stiffness.

Thus, diabetic neuropathy was found to be a determinant of cortical bone structure and bone strength at the tibia, potentially contributing to the increased nonvertebral fracture risk.

Reference:

Bone Microarchitecture and Strength in Long-Standing Type 1 Diabetes by Lilian Sewing, et al. published in the American Society for Bone and Mineral Research.

https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.4517

Keywords:

American Society for Bone and Mineral Research, Bone Microarchitecture, Strength, Long-Standing Type 1 Diabetes, diabetic neuropathy, Dual-energy X-ray absorptiometry, Type 1 diabetes, increased fracture risk, nonvertebral site, glycemic control, microvascular disease, skeletal health, Lilian Sewing, Laura Potasso, Sandra Baumann, Denis Schenk, Furkan Gazozcu, Kurt Lippuner, Marius Kraenzlin, Philippe Zysset, Christian Meier