Thursday, February 16, 2017

Type 1 Diabetes, Bone Density

Long Term Type 1, Bone Health Protection
The Joslin Medalist Study has examined more than 1000 people with 50 or more years of Type 1 diabetes. The purpose of the study is to find what makes the medalists different from so many other type 1 individuals who have had diabetes related complications. The study began in 2005, and is ongoing. I participated in the study in 2009. In 2011, I attended a medalist meeting at the Joslin Medical Center. Dr King, head of the project, announced that a large group of the participants in the study have some kind of "inner protection" that has prevented them from having any serious complications with their eyes, kidneys, and nervous systems. He also said that the inner protection does not protect our hearts, and that we should do our best to have good heart health. Many medalists have had heart by-passes. I have been type 1 for 71 years, and except for some very minor nerve damage, including neuropathy , I do not have any of these complications. My heart is also in good shape.
A study of a subgroup of these participants was done at the Bone Density Center of the Mass General Hospital. It was determined that the long term diabetics examined have a protective factor preventing bone health deterioration. The following abstract shows the details of the subgroup study:
Protection from Fracture Risk in Long Term Type 1 Diabetes: 50- Year Medalist Study
HILLARY KEENAN, SARA TUREK, STEPHANIE HASTINGS, GEORGE KING, Boston, MA.
Abstract:
Individuals with type 1 diabetes (T1D) have demonstrated a 12-fold increased risk of fragility fractures over their age-matched peers. As hospitalization for fracture is highly associated with decreased quality of life, morbidity and mortality this is an important, yet little studied diabetic complication particularly amongst those with extreme duration T1D. The 50-Year Medalist Study has extensively characterized over 800 individuals with a mean age of 69 y and duration of 55 y of T1D. Early examination of self-reported rates of hip, vertebral, and wrist fractures show extraordinarily low rates (0.33%, 0%, and 1.7%, respectively) in stark contrast to the 12-fold increase expected. To further examine these findings, 55 participants received DXA scans, 29 females, 26 males with a mean ±SD HbA1c of 7.2±0.8% and 7.0±1.2%, age 62.1±6.5 y and 66.7±6.8 y, and duration of 52.9±2.7 y and 55.8±5.1 y, respectively. BMI for this age group was low with 25.0±5.2 kg/m^2 for females and 27.3±4.4 kg/m^2 for males. T-scores, indicative of risk for fracture, for female 1/3 radius (1/3R) was -1.1±1.3, lumbar spine (LS) 0.1±1.2 and for the femoral neck (FN) -1.3±0.8. For males the 1/3R, T-score was -1.1±1.3, the LS was -0.1±1.9, and at the FN -1.3±0.8, none in the osteoporotic range. Total vitamin D, D2, D3 and calcium did not correlate with T scores among female or male, except for D3 among male and the LS T-score (R=0.5, p=0.03). There was no association of T scores with HbA1c, BMI, age or duration in either gender, p>0.05. As BMIs were low in male and female, the lower than expected risk T scores are likely not due to increase weight bearing as seen in T2D patients. These pilot data demonstrate protection from fracture, and low risk in this group with long term T1DM suggestive of a protective factor preventing bone health deterioration.

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