Diabetes Risk Factors and Bone Microarchitecture as Assessed by High-Resolution Peripheral Quantitative Computed Tomography in Adults With Long-Standing Type 1 Diabetes

Authors

Naina Sinha Gregory, Department of Medicine, Weill Cornell Medical College, New York, NY.
Andrew J. Burghardt, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
Jye-Yu C. Backlund, The Biostatistics Center, The George Washington University, Rockville, MD.
Mishaela R. Rubin, Department of Medicine, Columbia University, New York, NY.
Ionut Bebu, The Biostatistics Center, The George Washington University, Rockville, MD.
Barbara H. Braffett, The Biostatistics Center, The George Washington University, Rockville, MD.
David J. Kenny, The Biostatistics Center, The George Washington University, Rockville, MD.
Thomas M. Link, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
Galateia J. Kazakia, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
Annette Barnie, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
John M. Lachin, The Biostatistics Center, The George Washington University, Rockville, MD.
Rose Gubitosi-Klug, Department of Pediatrics, Case Western Reserve University/Rainbow Babies and Children's Hospital, Cleveland, OH.
Ian H. de Boer, Department of Medicine, University of Washington, Seattle, WA.
Ann V. Schwartz, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.

Document Type

Journal Article

Publication Date

11-29-2023

Journal

Diabetes care

DOI

10.2337/dc23-0839

Abstract

OBJECTIVE: To determine whether type 1 diabetes and its complications are associated with bone geometry and microarchitecture. RESEARCH DESIGN AND METHODS: This cross-sectional study was embedded in a long-term observational study. High-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal and diaphyseal tibia were performed in a subset of 183 participants with type 1 diabetes from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study and 94 control participants without diabetes. HbA1c, skin advanced glycation end products (AGEs), and diabetes-related complications were assessed in EDIC participants with >30 years of follow-up. RESULTS: Compared with control participants (aged 60 ± 8 years, 65% female), EDIC participants (aged 60 ± 7 years, diabetes duration 38 ± 5 years, 51% female) had lower total bone mineral density (BMD) at the distal radius (-7.9% [95% CI -15.2%, -0.6%]; P = 0.030) and distal tibia (-11.3% [95% CI -18.5%, -4.2%]; P = 0.001); larger total area at all sites (distal radius 4.7% [95% CI 0.5%, 8.8%; P = 0.030]; distal tibia 5.9% [95% CI 2.1%, 9.8%; P = 0.003]; diaphyseal tibia 3.4% [95% CI 0.8%, 6.1%; P = 0.011]); and poorer radius trabecular and cortical microarchitecture. Estimated failure load was similar between the two groups. Among EDIC participants, higher HbA1c, AGE levels, and macroalbuminuria were associated with lower total BMD. Macroalbuminuria was associated with larger total area and lower cortical thickness at the distal radius. Higher HbA1c and AGE levels and lower glomerular filtration rate, peripheral neuropathy, and retinopathy were associated with deficits in trabecular microarchitecture. CONCLUSIONS: Type 1 diabetes is associated with lower BMD, larger bone area, and poorer trabecular microarchitecture. Among participants with type 1 diabetes, suboptimal glycemic control, AGE accumulation, and microvascular complications are associated with deficits in bone microarchitecture and lower BMD.

APA Citation

Sinha Gregory, Naina; Burghardt, Andrew J.; Backlund, Jye-Yu C.; Rubin, Mishaela R.; Bebu, Ionut; Braffett, Barbara H.; Kenny, David J.; Link, Thomas M.; Kazakia, Galateia J.; Barnie, Annette; Lachin, John M.; Gubitosi-Klug, Rose; de Boer, Ian H.; and Schwartz, Ann V., "Diabetes Risk Factors and Bone Microarchitecture as Assessed by High-Resolution Peripheral Quantitative Computed Tomography in Adults With Long-Standing Type 1 Diabetes" (2023). GW Authored Works. Paper 3750.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3750

Department

Biostatistics and Bioinformatics