Type 1 Diabetes and Bone Fragility: Links and Risks

Abstract

Type 1 diabetes (T1D) is associated with an increased fracture risk, which is present at young and old age. Reductions in bone mineral density do not explain the increased fracture risk. Novel scanning modalities suggest that structural deficits may contribute to the increased fracture risk. Furthermore, T1D may due to insulinopenia be a state of low bone turnover. However, diabetes complications and comorbidities may influence fracture risk. Patients with T1D are fearful of falls. The diabetes related complications, hypoglycemic events, and antihypertensive treatment may all lead to falls. Thus, the increased fracture risk in T1D seems to be multifactorial, and earlier intervention with antiosteoporotic medication and focus on fall prevention is needed. This systematic review addresses the epidemiology of fractures and osteoporosis in patients with T1D and the factors that influence fracture risk.

Keywords:

• type 1 diabetes
• osteoporosis
• fracture
• falls
• bone mineral density

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. All authors have approved the final version of the manuscript.

Funding

The authors received no funding for the presented work.

Disclosure

JSL reports personal fees from Gilead Sciences Denmark outside the submitted work. BL has received research grants to institution from Amgen and Novo Nordisk and serves on the advisory boards and/or performs lectures for Amgen, UCB, and Eli Lilly. The authors report no other conflicts of interest in this work.