Adults with diabetes may risk thinning bones

Men with Type 1 diabetes are at an increased risk of developing osteoporosis, according to an Australian study.

Men with Type 1 diabetes show drop in bone density at a rate similar to older, post-menopausal women with Type 2 diabetes

Men with Type 1 diabetes are at an increased risk of developing osteoporosis, according to an Australian study.

The study, published in Acta Diabetology, reveals that over five years men with Type 1 diabetes show a drop in bone density at a rate similar to older, post-menopausal women with Type 2 diabetes.

Osteoporosis is emerging as a complication in diabetes, an Australian researcher says. (Darin Oswald/The Idaho Statesman/Associated Press)

First author Dr. Emma Hamilton, of the University of Western Australia's School of Medicine and Pharmacology at Fremantle Hospital says the findings suggest young men with Type 1 diabetes need to do weight-bearing exercise and supplement their diets with calcium and vitamin D to delay bone degeneration.

Hamilton says the research follows on from previous epidemiological studies that had suggested a link between Type 1 diabetes and an increase rate in fractures.

People with Type 1 have an almost seven times (6.3-6.9) higher risk of fracture, while those with Type 2 diabetes have a 1.4-1.7 higher risk of fracture, the researchers found.

This study, one of very few to have examined longitudinal changes in bone mineral density and bone metabolism in diabetes, confirms these observations and suggests gender may play a role in bone loss in Type 1 diabetics.

For the five-year study, Hamilton and colleagues studied 26 Type 1 (17 men, nine women) and 27 Type 2 (16 men, 11 women) diabetic patients.

In Type 1 diabetes the body cannot produce insulin so people with this condition require daily insulin injections. Type 2 diabetes — the most common form — normally develops later in life and can initially be maintained through healthy eating and exercise.

Bone called 'dynamic organ'

Hamilton and her team measured bone mineral density and bone turnover at the start of the study in 2000 and 2001 and then five years later.

Bone density is a measure of the strength of the bone, while measurements of bone turnover tracks the body's ability to form new bone and remove defective bone.

Hamilton says many people did not realize that bone is an "incredibly dynamic organ" with cells constantly removing defective bone and forming new bone.

The current study shows Type 1 diabetic men lost bone density "quite quickly."

Hamilton says the reasons behind the impact on Type 1 males remains unclear although the Type 1 female participants remained pre-menopausal and increased their body mass index over the course of the study.

She says these factors may have offset the "deleterious effect" of diabetes on bone strength and may reflect that accelerated bone loss only becomes evident in Type 1 women post-menopause.

By contrast, over the course of the study those with Type 2 diabetes had improved bone density after five years, with insulin acting as an anabolic to build up bone.

Despite this, Hamilton says Type 2 diabetics still have a higher risk of breaking bones than the normal population.

"It might be about the quality of bone that is deposited or complications with poor eyesight makes them more predisposed to falling over," she tells the Australian Broadcasting Corporation.

"There is quite a complex interplay of factors that could be involved."

While the impact of gender on bone loss in Type 1 diabetes is quite clear from the results, Hamilton says it would be wrong to extrapolate from this "small" study.

"We have found this trend in our group, but it is not clear whether this is a wider issue or something particular to our small group," she says.

She says other longitudinal studies have shown no difference based on gender, however these studies were different in design.

She says the study does confirm that osteoporosis is "definitely emerging as a complication in diabetes".

Hamilton says a larger longitudinal study is needed to clarify the relationship between diabetes, bone density and fractures.