Bone mineral density in patients with longstanding type 1 diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes

Aim: It is currently unclear if longstanding type 1 diabetes (T1D) affects bone mineral density (BMD). Methods: BMD measured by dual-energy X-ray absorptiometry and history of fragility fracture was determined in 75 T1D participants with >= 50 years of diabetes duration and 75 age- and sex-matched non-diabetic controls. BMD T-scores were determined for the lumbar spine (LS), total hip (TH) and femoral neck (FN). Results: T1D participants had median diabetes duration of 54 [52, 58] years, 41 (55%) were females, and mean A1c was 7.3 +/- 0.8%. T1D females had higher LS T-scores compared to female controls (-0.3 +/- 1.2 vs. -1.1 +/- 1.4, p = 0.014), lower FN T-scores (-1.5 +/- 1.0 vs. -1.2 +/- 0.9, p = 0.042) and more fragility fractures (7 (17%) vs. 1 (2%), p = 0.021). In T1D, higher A1c was associated with higher adjusted odds of fragility fracture (p = 0.006). T1D males and controls showed no difference in BMD or fractures. Conclusions: There were no substantial differences in T-score between T1D and matched controls; however, T1D females showed higher BMD at the LS and possibly paradoxically higher fragility fractures compared to matched controls. These findings suggest that lower T-scores may not be associated with a history of fragility fracture in females with longstanding T1D and that other factors should be investigated. (C) 2019 Elsevier Inc. All rights reserved.