title: Bone health in subjects with type 1 diabetes for more than 50 years.
abstract: OBJECTIVE
  Few data regarding prevalence of and risk factors for poor bone health in aging individuals with long-standing T1D are available. In this study, we aim to describe the prevalence of bone fragility and to identify factors associated with low bone density in individuals with long-term T1D.
  
  
  METHODS
  We examined the prevalence of non-vertebral fractures in 985 subjects enrolled in the Joslin 50-Year Medalist Study and measured bone mineral density (BMD) by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine and radius in a subset (65 subjects, mean age 62.6 years, duration 52.5 years, HbA1c 7.1%) with no significant clinical or demographic differences from the rest of the cohort.
  
  
  RESULTS
  Medalists have low prevalence of fractures (0.20% hip and 0.91% wrist) and normal Z-score values (spine +1.15, total hip +0.23, femoral neck -0.01, radius +0.26; p > 0.05 for differences vs. 0 at all sites). A significant relationship was found between lower BMD and higher total cholesterol, triglycerides and LDL levels, but not HbA1c. Low BMD at the femoral neck was associated with cardiovascular disease after adjustment for confounding factors: prevalence risk ratio of CVD [95% CI] 4.6 [1.2-18.1], p = 0.03. No other diabetic vascular complication was found to be associated with low BMD.
  
  
  CONCLUSIONS
  These are the first data regarding bone health in aging individuals who have had diabetes for 50 or more years. The low rates of non-vertebral fractures and the normal Z-score suggest the long T1D diabetes duration did not increase the risk of bone fractures in Medalists compared to non-diabetic peers. Additionally, the association with cardiovascular disease demonstrates the BMD differences in groups are likely not due to glycemic control alone.
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.|Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Maddaloni
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: D'Eon
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hastings
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
authors.forename: Liane J
authors.initials: LJ
authors.lastname: Tinsley
authors.affiliation: Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
authors.forename: Mogher
authors.initials: M
authors.lastname: Khamaisi
authors.affiliation: Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bouxsein
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
authors.forename: Savitri M R
authors.initials: SMR
authors.lastname: Fouda
authors.affiliation: Research Division, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA. hillary.keenan@joslin.harvard.edu.
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Keenan
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015519:Bone Density / Q000502:physiology*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D014280:Triglycerides
keywords: Aging; Bone fractures; Bone mineral density; Low bone mass; Osteoporosis; Type 1 diabetes