ADA: Osteoporosis Common in Diabetes
Patients
Australian doctors are urging clinicians to consider
screening their diabetic patients for osteoporosis.
Dr. Wendy Davis, from the University of Western
Australia in Fremantle, and colleagues, issued
the recommendation following research that found
that previously unrecognized osteoporosis is common
in patients with diabetes.
She presented her findings at the 63rd Scientific
Sessions of the American Diabetes Association.
"The relationship between diabetes and osteoporosis
appears complex," Dr. Davis said. "In
type 1 diabetes, there is evidence of low bone
mineral density [BMD] at peripheral sites which
is associated with diabetes diagnosis before puberty,
poor glycemic control, high insulin requirements,
and microvascular complications," she added.
"In type 2 diabetes, there is normal or even
increased BMD [bone mineral density]."
Studies of BMD in diabetes have been largely
small scale and/or clinic based, with a likely
over-representation of poorly controlled patients
with complications, she continued. Active exclusion
of patients with other osteoporotic risk factors
may mean that an additive or synergistic relationship
with diabetes and BMD is missed.
The screening/management of osteoporosis in diabetic
patients would be improved if there were more
data on the prevalence and association of osteoporosis
in diabetes in a community setting, she said.
The present study aimed to assess the prevalence
and predictors of osteoporosis in diabetes in
a community-based urban Australian setting.
Subjects included 35 patients with type 1 diabetes
and 189 with type 2 but with no history of osteoporosis
or of use of drugs for this condition.
Each patient underwent dulia energy X-ray absorptiometry
scanning of the hip, spine, and forearm, and Z
and T scores were generated.
Overall ten of 24 male type 1 diabetics (42%)
had a T score less than -2.5 at the femoral neck
versus zero of 11 females. Nine of 102 men with
type 2 diabetes (9%) had a T score less than -2.5
versus 12 of 85 (14%) of females.
Overall, 31% had type 1 patients with at least
one T score less than -2.5 and 16% had type 2
diabetes and had at least one T score less than
-2.5.
Further analysis revealed that T scores were
consistently and independently associated with
body mass index (BMI) and age but not gender,
duration of diabetes, or diabetes type. For each
Z score, BMI and diabetes type were independent
predictors (P<0.022), but gender and duration
were not.
"The data show that previously unrecognized
osteoporosis is common in diabetes irrespective
of diabetes type," Dr. Davis said.
While an increase BMI may confer protection against
low BMD in type 1 diabetes, lean individuals with
type 1 diabetes are at significantly increased
risk of osteoporosis and may be good candidates
for routine DEXA screening, she advised.
[Study title: Bone Mineral Density in Diabetic
Patients without a History of Osteoporosis: The
Fremantle Diabetes Study. Abstract 935]
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FACT:
The International Obesity Task Force estimates
that more than 1.1 billion people are overweight,
including 320 million who are obese. (IOTF)
