Abstract
In this single‐center, cross‐sectional study, we demonstrated that the prevalence of fracture was significantly higher in patients who onset type 1 diabetes during 0–4 years, and 10–14 years compared with adult‐onset type 1 diabetes. We are aware that this study contains a lot of limitations including non‐prospective study design and a small number of participants. However, the results of this study, if followed by a larger cohort study, could provide important insights into the increased risk of fracture in patients with type 1 diabetes, and suggest the need for attention and perhaps early intervention for patients with type 1 diabetes who developed during these periods.
Dear Editor,
Type 1 diabetes is associated with an increased risk of bone fracture, although the full mechanism is to be elucidated. Bone growth is the greatest during two main stages – the infant and pubertal years – when the musculoskeletal system grows the most. Although some recent studies have reported that patients with childhood‐onset type 1 diabetes had greater deficits in bone density 1 , no study has investigated these two stages in detail.
The present single‐center, cross‐sectional study was carried out with 388 Japanese patients aged ≥20 years who had type 1 diabetes and attended the Clinic Masae Minami (Fukuoka, Japan) between October 2019 and April 2020 2 . We evaluated the relationships between onset age of type 1 diabetes and the history of fracture using multivariate‐adjusted logistic regression analysis.
The mean age of participants was 45.1 years, and 42.2% were men. A total of 64 patients experienced fractures after a diagnosis of diabetes. Figure 1 shows the odds ratios for the prevalence of fracture according to the onset age of type 1 diabetes. Compared with those who had onset of type 1 diabetes during 25–29 years, the multivariate‐adjusted odds ratio for fracture was 8.41 (95% confidence interval 1.22–68.27) in patients who had onset of type 1 diabetes aged 0–4 years, and 5.49 (95% confidence interval 1.34–25.46) in patients who had onset of type 1 diabetes aged 10–14 years.
Figure 1.
Multivariate‐adjusted odds ratios of the prevalence of fracture according to onset age of type 1 diabetes. Multivariate adjustments include age, sex, body mass index, duration of diabetes, current smoking habit, current drinking habit, exercise habit, family history of hip fracture, hemoglobin A1c, diabetic neuropathy, retinopathy, nephropathy and the history of severe hypoglycemia. CI, confidence ratio; OR, odds ratio.
Insulin deficiency and hyperglycemia can affect the bone cells functions, resulting in impairing the bone strength, geometry and microarchitecture 3 . These negative associations are speculated to be greatest just after onset of type 1 diabetes because of the difficulty of optimizing insulin replacement therapy 4 . Thus, developing type 1 diabetes during the periods of greatest bone growth might result in decreased bone formation, and reduced peak bone mass in adulthood. Our study suggests that timing of type 1 diabetes onset might be important for estimating lifetime fracture risk in patients with type 1 diabetes.
We are aware that the present study contains many limitations, including non‐prospective study design and a small number of participants. However, the results of this study, if followed by a larger cohort study, could provide important insights into the increased risk of fracture in patients with type 1 diabetes, and suggest the need for attention and perhaps early intervention for patients who developed type 1 diabetes during these periods.
DISCLOSURE
The authors declare no conflict of interest.
Approval of the research protocol: The Clinic Masae Minami Institutional Review Board.
Informed consent: Written informed consent was obtained from all the participants.
Approval number: MERC‐19‐001, Approval date: 1 October 2019.
Animal studies: N/A.
ACKNOWLEDGMENTS
This work was supported in part by JSPS KAKENHI (grant numbers 20K19663), Honjo International Scholarship Foundation, All Japan Coffee Association, the Nakatomi Foundation, the Clinical Research Promotion Foundation and the Kondou Kinen Medical Foundation.
REFERENCES
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