Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, IL, USA.
Osteoporos Int. 2009 Jun;20(6):923-33. doi: 10.1007/s00198-008-0763-3. Epub 2008 Oct 2.
The etiology of bone fragility in individuals with type 1 diabetes is unknown. This study demonstrated that bone turnover favors resorption and that poor glycemic control is associated with low bone mineral density (BMD) and low bone turnover, in premenopausal women with type 1 diabetes. The results could inform future interventions.
Low BMD and fracture may be complications of type 1 diabetes. We sought to determine the roles of bone turnover and glycemic control in the etiology of low BMD.
Premenopausal women from the Wisconsin Diabetes Registry Study and matched controls were compared (n = 75 pairs). Heel and forearm BMD were measured, and hip and spine BMD were measured in a subset. Markers of bone formation (osteocalcin) and resorption (NTx), and glycemic control (HbA1c) were determined.
Age ranged from 18 to 50 years with a mean of 28, and 97% were Non-Hispanic white. Among women with diabetes, mean disease duration was 16 years and current HbA1c was 8%. Compared to controls, women with diabetes had a high prevalence of previous fracture (37% vs. 24%) and low BMD for age (heel or forearm: 49% vs. 31%), low heel and forearm BMD, and low osteocalcin levels. Levels of NTx were similar, suggesting uncoupled turnover favoring resorption. Poor glycemic control was associated with low BMD at all bone sites except the spine, and with low osteocalcin and NTx levels.
Optimal glycemic control may prevent low BMD and altered bone turnover in type 1 diabetes, and decrease fracture risk.
1 型糖尿病患者的骨脆弱病因尚不清楚。本研究表明，骨转换有利于吸收，且血糖控制不佳与骨密度（BMD）降低和低骨转换有关，在患有 1 型糖尿病的绝经前女性中更是如此。研究结果可能为未来的干预措施提供信息。
低 BMD 和骨折可能是 1 型糖尿病的并发症。我们试图确定骨转换和血糖控制在低 BMD 病因中的作用。
来自威斯康星州糖尿病登记研究的绝经前女性患者和匹配的对照组进行比较（n = 75 对）。测量脚跟和前臂 BMD，并在亚组中测量髋部和脊柱 BMD。测定骨形成标志物（骨钙素）和骨吸收标志物（NTx）以及血糖控制指标（HbA1c）。
年龄在 18 至 50 岁之间，平均年龄为 28 岁，97%是非西班牙裔白人。在患有糖尿病的女性中，平均患病时间为 16 年，目前的 HbA1c 为 8%。与对照组相比，患有糖尿病的女性既往骨折发生率较高（37% vs. 24%），年龄相关的 BMD 较低（脚跟或前臂：49% vs. 31%），脚跟和前臂 BMD 较低，骨钙素水平较低。NTx 水平相似，表明转换失衡有利于吸收。血糖控制不佳与所有骨骼部位的 BMD 降低（除脊柱外）、骨钙素和 NTx 水平降低有关。
优化血糖控制可能预防 1 型糖尿病患者的低 BMD 和骨转换异常，并降低骨折风险。
