Starup-Linde Jakob, Støy Julie, Grinderslev Pernille Bundgaard, Langdahl Bente, Harsløf Torben
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Osteoporos Int. 2025 May;36(5):823-831. doi: 10.1007/s00198-025-07443-y. Epub 2025 Mar 18.
The prevalence of osteoporosis in individuals with type 1 diabetes (T1D) was investigated. Based on IOF/ADA recommendations, 36% had indications for anti-osteoporotic therapy. We propose that postmenopausal women and men with T1D and age > 50 years are screened for osteoporosis.
Type 1 diabetes is associated with an increased fracture risk and a lowering of the threshold for osteoporosis treatment has been recommended to be increased from a bone mineral density of a T-score ≤ - 2.5 to a T-score ≤ - 2.0. In this study, we aimed to investigate the prevalence and risk factors for osteoporosis in type 1 diabetes using the classic diagnostic criteria defined by WHO and the novel T-score cutoff of - 2.0 proposed by the ADA.
In a cross-sectional study, data were collected from the type 1 diabetes clinic at Steno Diabetes Center Aarhus, Aarhus University Hospital, where active attenders in the clinic were offered screening for osteoporosis using DXA of the lumbar spine and hip in the time period 2020-2022.
A total of 764 individuals with type 1 diabetes had a DXA and of these, 25.5% had osteoporosis based on a vertebral fracture or T-score ≤ - 2.5, and 36% met ADA-treatment criteria with a vertebral fracture or T-score ≤ - 2.0. In multivariate analysis increasing age (OR = 1.3, 95% CI 1.0; 1.7) and a family history of osteoporosis (OR = 1.9, 95% CI 1.2; 3.0) were associated with an increased risk of osteoporosis, whereas an increase in BMI was associated with a decreased risk of osteoporosis (OR = 0.87, 95% CI 0.82; 0.92).
The present study finds that a high proportion of individuals with type 1 diabetes have osteoporosis, and an even higher proportion meet the treatment criteria proposed by the ADA, and thus, early detection and treatment of osteoporosis may reduce the apparent increased fracture risk in type 1 diabetes.
对1型糖尿病（T1D）患者的骨质疏松症患病率进行了调查。根据国际骨质疏松症基金会/美国糖尿病协会的建议，36%的患者有抗骨质疏松治疗指征。我们建议对绝经后患有T1D且年龄>50岁的女性和男性进行骨质疏松症筛查。
1型糖尿病与骨折风险增加相关，并且建议将骨质疏松症治疗阈值从骨密度T值≤-2.5提高到T值≤-2.0。在本研究中，我们旨在使用世界卫生组织定义的经典诊断标准和美国糖尿病协会提出的新的T值临界值-2.0来调查1型糖尿病患者骨质疏松症的患病率和危险因素。
在一项横断面研究中，从奥胡斯大学医院斯滕诺糖尿病中心的1型糖尿病诊所收集数据，在2020 - 2022年期间，为该诊所的活跃就诊者提供腰椎和髋部双能X线吸收法（DXA）骨质疏松症筛查。
共有764例1型糖尿病患者接受了DXA检查，其中25.5%基于椎体骨折或T值≤-2.5患有骨质疏松症，36%符合美国糖尿病协会的治疗标准，即椎体骨折或T值≤-2.0。在多变量分析中，年龄增加（比值比[OR]=1.3，95%置信区间[CI]1.0；1.7）和骨质疏松症家族史（OR=1.9，95%CI 1.2；3.0）与骨质疏松症风险增加相关，而体重指数（BMI）增加与骨质疏松症风险降低相关（OR=0.87，95%CI 0.82；0.92）。
本研究发现，高比例的1型糖尿病患者患有骨质疏松症，甚至更高比例的患者符合美国糖尿病协会提出的治疗标准，因此，早期发现和治疗骨质疏松症可能会降低1型糖尿病患者明显增加的骨折风险。
