title: Different health behaviours and clinical factors associated with bone mineral density and bone turnover in premenopausal women with and without type 1 diabetes.
abstract: BACKGROUND
  Women with type 1 diabetes (T1DM) have an elevated fracture risk. We therefore compared the associations of health behaviours and clinical factors with bone mineral density (BMD) and bone remodelling between premenopausal women with and without T1DM to inform potential interventions.
  
  
  METHODS
  Participants included women with T1DM (n = 89) from the Wisconsin Diabetes Registry Study and age-matched and race-matched controls without diabetes (n = 76). Peripheral (heel and forearm) and central (hip and spine) BMD, markers of bone resorption and formation, bone cell signalling, glycaemic control, and kidney function were assessed. Health behaviours and medical history were self-reported.
  
  
  RESULTS
  In controls, but not in women with T1DM, older age was associated with lower bone resorption (p ≤ 0.006) and formation (p = 0.0007). Body mass index was positively associated with heel and forearm BMD in both controls and T1DM women (all p < 0.0001), but with hip and spine BMD only in controls (p ≤ 0.005). Worse glycaemic control during the previous 10 years, greater alcohol intake, history of smoking, and lack of physical activity were associated with poorer bone outcomes only in women with T1DM (all p ≤ 0.002), whereas use of hormonal contraceptives was related to low bone formation in both women with and without T1DM (all p ≤ 0.006). Diabetes duration, insulin dose, residual C-peptide, and kidney function were not associated with bone in T1DM.
  
  
  CONCLUSIONS
  Age and body mass index may not predict bone health in T1DM women. However, modifiable behaviours such as optimizing glycaemic control, limiting substance and hormonal contraceptive use, and increasing physical activity may improve bone health in T1DM women.
authors.affiliation: College of Nursing, Rush University, Chicago, IL, USA.
authors.forename: Amber S
authors.initials: AS
authors.lastname: Kujath
authors.forename: Lauretta
authors.initials: L
authors.lastname: Quinn
authors.forename: Mary E
authors.initials: ME
authors.lastname: Elliott
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: LeCaire
authors.forename: Neil
authors.initials: N
authors.lastname: Binkley
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Molino
authors.forename: Kirstie K
authors.initials: KK
authors.lastname: Danielson
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D016723:Bone Remodeling; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D015994:Incidence; D009043:Motor Activity; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010349:Patient Compliance; D012042:Registries; D012307:Risk Factors; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: bone mineral density; bone turnover markers; glycaemic control; type 1 diabetes