title: Bone Structure and Predictors of Fracture in Type 1 and Type 2 Diabetes.
abstract: BACKGROUND
  Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture.
  
  
  OBJECTIVE
  The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations.
  
  
  METHODS
  This was a cross-sectional study.
  
  
  METHODS
  Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study.
  
  
  METHODS
  Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Blood samples were collected for bone turnover markers. Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray, and incident fractures were collected from The Danish National Hospital Discharge Register.
  
  
  RESULTS
  Bone mineral density (BMD) was higher in type 2 than type 1 diabetes patients at the hip, femur, and spine; however, only the hip differed in multivariate-adjusted models. Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models. Sclerostin levels were inversely associated with fracture in type 1 diabetes patients. The patients with the highest tertile of sclerostin had an 81% decreased risk of a fracture compared with the lowest tertile.
  
  
  CONCLUSIONS
  Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia. Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance. Studies with longer follow-up are needed.
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Starup-Linde
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Simon
authors.initials: S
authors.lastname: Lykkeboe
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Gregersen
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Ellen-Magrethe
authors.initials: EM
authors.lastname: Hauge
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Bente Lomholt
authors.initials: BL
authors.lastname: Langdahl
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Aase
authors.initials: A
authors.lastname: Handberg
authors.affiliation: Departments of Endocrinology and Internal Medicine (J.S.-L., S.G., L.L.) and Rheumatology (E.-M.H.), Aarhus University Hospital, DK-8000 C Aarhus, Denmark; Department of Clinical Medicine (J.S.-L., A.H., P.V.), Aalborg University, DK-9220 Aalborg, Denmark; Departments of Clinical Biochemistry (S.L., A.H.) and Endocrinology (P.V.), Aalborg University Hospital, DK-9000 Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D019485:Bone Morphogenetic Proteins / Q000097:blood; D016723:Bone Remodeling; D001842:Bone and Bones / Q000473:pathology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000473:pathology*; D005260:Female; D050723:Fractures, Bone / Q000473:pathology*; D005819:Genetic Markers; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D015415:Biomarkers; D019485:Bone Morphogenetic Proteins; D005819:Genetic Markers; C422903:SOST protein, human