title: Bone mineral density in patients with type 1 and type 2 diabetes.
abstract: OBJECTIVE
  To assess the effect of type 1 and type 2 diabetes and insulin treatment on bone mineral density (BMD) in middle-aged and elderly men and women.
  
  
  METHODS
  We measured BMD and evaluated known determinants of osteoporosis in 56 type 1 and 68 type 2 diabetic patients and 498 nondiabetic community control subjects. All patients, aged 52-72 years, developed diabetes after the age of 30 years (i.e., after achievement of peak bone mass) and were treated with insulin. BMD was measured at the proximal femur with dual-energy X-ray absorptiometry.
  
  
  RESULTS
  Among both sexes, BMD values were significantly lower in type 1 diabetic patients than in type 2 diabetic patients or the control subjects. When adjusted for age and BMI, the differences between type 1 diabetic patients and control subjects remained essentially unchanged in both sexes, whereas the differences between type 1 and type 2 diabetic subjects were significant only in men. After further adjustments for confounding factors, the average BMD values were still lower in type 1 diabetic subjects than in type 2 diabetic subjects although with lesser significance. Past low-energy fractures were more common in type 1 diabetic women than in type 2 diabetic women.
  
  
  CONCLUSIONS
  The lower BMD in type 1 versus type 2 diabetic patients and control subjects probably results from more rapid bone loss after the onset of type 1 diabetes. This cannot be explained by insulin treatment, which was prescribed for both types of patients. Because the causes of low BMD in type 1 diabetes are unknown, these patients should be evaluated for the risk of osteoporosis and related fractures and offered appropriate preventive measures.
authors.affiliation: Department of Medicine, University of Turku, Finland.
authors.forename: J T
authors.initials: JT
authors.lastname: Tuominen
authors.forename: O
authors.initials: O
authors.lastname: Impivaara
authors.forename: P
authors.initials: P
authors.lastname: Puukka
authors.forename: T
authors.initials: T
authors.lastname: Rönnemaa
mesh_terms: D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking; D015519:Bone Density; D002136:Calcium, Dietary; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D008297:Male; D008572:Menarche; D008593:Menopause; D008875:Middle Aged; D010809:Physical Fitness; D012016:Reference Values; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking
chemical_list: D002136:Calcium, Dietary