title: A five-year prospective study of bone mineral density in men and women with diabetes: the Fremantle Diabetes Study.
abstract: To examine longitudinally the effect of diabetes on bone structure and metabolism, we measured bone mineral density (BMD) and turnover markers in 26 type 1 (mean age 49 years) and 27 type 2 (mean age 65 years) diabetic patients without known osteoporosis from a community-based sample at baseline and 5 years later. In the 17 type 1 men, BMD fell at the femoral neck (0.804 ± 0.145 vs. 0.769 ± 0.129 g/cm(2); P = 0.003) with no change at lumbar spine or forearm. In the 11 type 2 women, BMD decreased at all sites except spine (femoral neck 0.779 ± 0.119 vs. 0.742 ± 0.090 g/cm(2); P = 0.019). BMD did not fall at any site in type 1 women or type 2 men. There was an increase in serum alkaline phosphatase and trend to higher serum beta carboxyl-terminal type I collagen telopeptide concentrations in the type 1 patients, and a decrease in free testosterone in the type 1 men. These data show that the rate of demineralization at the femoral neck in type 1 men is similar to that in older post-menopausal type 2 women. Changes in biochemical markers suggest that, in type 1 men, there is ineffective bone formation associated with accelerated bone resorption and lower sex steroid bioavailability. These findings may have implications for the clinical management of young male adults with diabetes.
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, WA, Australia.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Hamilton
authors.forename: Valentina
authors.initials: V
authors.lastname: Rakic
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.forename: S A
authors.initials: SA
authors.lastname: Paul Chubb
authors.forename: Niklaus
authors.initials: N
authors.lastname: Kamber
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prince
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D024042:Collagen Type I / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies
chemical_list: D024042:Collagen Type I; D000469:Alkaline Phosphatase