Issue 160 Item13 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]

================================
FACT: The International Obesity Task Force estimates that more than 1.1 billion people are overweight, including 320 million who are obese. (IOTF)