Diagnostics & Imaging Week
A new study to be published in the February issue of Diabetes Care shows that premenopausal women who have Type 1 diabetes should strongly consider preventive screening for osteoporosis, according to the researchers.
The study found that those women exhibited lower bone density and more fractures than women who did not have diabetes, even though those with diabetes were more likely to take bone-active osteoporosis medications and vitamin D supplements. Both groups of women exercised a similar number of hours per week.
According to lead researcher Elsa Strotmeyer, PhD, assistant professor in the department of epidemiology at the University of Pittsburgh, the study was only in women and it looked at bone density in Type 1 diabetic women compared to non-diabetic women who are at the same age.
"There have been several prospective studies that have found that Type 1 diabetic women who are older have a greater risk for fracture, so we hypothesized that this might be due to lower bone density at an earlier age in these women," Strotmeyer told Diagnostics & Imaging Week.
Previously, as was noted in the study, "The impact of the menopause transition on osteoporosis in Type 1 diabetes is now well established."
The 67 women in the study were aged 35-55 years with Type 1 diabetes and 237 without diabetes. "All participants were part of a volunteer subgroup from the ProHealth Study, a prospective study to determine whether menopause occurs at a significantly younger average age among Type 1 diabetic compared with nondiabetic women," the study said.
According to the paper, "Total hip, femoral neck, whole-body and spine BMD were measured by dual X-ray absorptiometry. Calcaneal broadband ultrasound attenuation was assessed with quantitative ultrasound." All of the equipment used in the study was from Hologic (Bedford, Massachusetts), Strotmeyer said, including the Dexascan for bone mineral density.
"I'll tell you why we used the ultrasound," she said. "The quantitative ultrasound machine they have for looking at bone assesses bone at the heel, and we hypothesized that some of the complications of Type 1 diabetes [such as] peripheral neuropathy and peripheral arterial disease disease, may be affecting bone at peripheral locations more than they would at central locations like the hip." Strotmeyer told D&IW.
The conclusions from the study were that Type 1 diabetes in middle-aged women was associated with a 3% to 8% lower BMD at the total hip, femoral neck and whole body.
Women with Type 1 diabetes were more likely to report a fracture after age 20 years compared with nondiabetic women. Also in the Type 1 diabetic women, "reduced monofilament detection and blindness were both associated with lower BMD."
Therefore, since lower BMD in premenopausal women with Type 1 diabetes "may substantially increase the risk of developing osteoporosis after menopause," they should be targeted for screening as this transition takes place. Strotmeyer said there is no clear age cutoff for starting the screening, since menopause occurs at different ages for different women.
"Currently, there are no guidelines that recommend screening before menopause," she said. "All the guidelines for clinical screening for women are for after menopause. So, what we're suggesting in our study is that Type 1 diabetic women should be assessed for osteoporosis as they go through the menopause, when people start having a greater risk for osteoporosis."