Jornal de Osteoporose e Atividade Física
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Bone Mineral Density in Bulgarian Patients with Type 1 Diabetes Mellitus

Nikolay Botushanov, Marianna Yaneva, Maria Orbetzova and Albena Botushanova

Aim of the study: To examine the bone mineral density (BMD) in Bulgarian patients with type 1 diabetes mellitus (DM) in comparison to age- sex- and ethnically matched healthy controls and its correlation with bone turnover markers: oteocalcin as a marker of bone formation and deoxypyridinoline cross-laps as bone resorption marker.

Materials and methods: 162 patients with type 1 DM (97 females and 65 males) age 29.17 yrs. (20-40) and 200 (100 women and 100 men) age- and sex matched healthy controls were analyzed for BMD and Z-score of lumbar spine and femoral neck by dual X-ray absorptiometry (DXA) using Lunar DPX-A. Plasma levels of osteocalcin and urine levels of deoxypyridinoline cross-laps were determined.

Results: BMD in type 1 DM showed statistically significant lower levels for lumbar spine L1-L4- men (1.2114 g/ cm² ± 0,1587 DM vs. 1.3346 g/ cm² ± 0,1635 controls, P<0.05) and L1-L4 women (1.1035 g/cm² ± 0.1269 DM vs 1.1978 g/ cm² ± 0,1269 controls, P<0.05) and femoral neck - men (0.9138 g/cm² ± 2134 DM vs 0.9868 g/ cm² ± 0.1534 controls, P<0.05) and women (0.8656 g/cm² ± 0.1223 DM vs 0.9236 g/ cm² ± 0.145 controls, P<0.05) in both sexes in comparison with that in control group. We found no statistically significant difference for osteocalcin levels as a marker of bone formation in both groups (P=0.062), while deohypyridinoline (DPD) levels as a marker of bone resorption were significantly higher (P<0.01) in diabetic patients in comparison with age and sex matched controls. Osteocalcin showed significant negative correlation with BMD at lumbar spine (r=-0.418; P=0.004) and nonsignificant negative correlation with that at femoral neck (r=-0.271; P=0.078) in diabetic patients. DPD showed nonsignificant correlations with BMD at lumbar spine (r=-0.024; P=0.846) and at femoral neck (r=0.143; P=0.259) in diabetic patients.

Conclusions: BMD measured at lumbar spine and femoral neck was significantly lower in patients with type 1 DM than in age-and sex matched controls. Levels of the bone turnover markers indicate increased bone resorption as a reason for the decreased bone mineral content in diabetic patients. Prospective studies are needed to determine whether metabolic control of diabetes has any influence upon the observed bone changes and whether keeping good metabolic control can minimize the reduction of the bone mineral content like it happens with the diabetic microangioapthy. If we consider the reduction of the BMD to be a specific complication of type 1 diabetes mellitus than we should take appropriate measures to cope with this problem like stressing upon the importance of appropriate diet adequate physical activity especially at the time peak bone mass is being accumulated.