Bone Health in Adults with Type 1 Diabetes

摘要 患有1型糖尿病(T1D)的人患髋部骨折的风险是正常人的6到8倍 没有糖尿病。髋部骨折与严重的发病率、死亡率、独立性丧失和 经济负担。此外，与受试者相比，糖尿病患者髋部骨折死亡率更高。 没有糖尿病。 双x射线骨密度仪(DXA)是评估骨骼健康的最常见测试，它低估了 T1D患者。年轻起病的T1D(20岁前诊断为T1D)的几何结构改变，骨质减少 力学和材料性质与T1D的骨脆性有关。慢性高血糖和低血糖是 推测可以抑制骨周转，导致微损伤和晚期糖基化的积累 最终产品(年龄)导致T1D中的骨材料性能受损。尽管骨折风险较高，但 T1D对骨结构和材料特性以及影响骨健康的糖尿病相关因素的影响 未知。 考虑到知识差距，我们建议使用VALIDATED来评估基线骨骼表型 定量计算机断层扫描(QCT)、基于有限元(FE)的骨强度和OsteoProbe®- 体内测量的骨材料强度指数(BMSi)，以及这些测量在3年内的变化 患有和不患有T1D的成年人队列正在进行的“1型糖尿病的冠状动脉钙化” (仙人掌)研究。我们还将确定急性高血糖和低血糖对骨转换的作用及其 对骨材料性能的长期影响。 随着护理的改善，患有T1D的人寿命更长，而且没有具体的预防和治疗方法 T1D治疗老年人骨质疏松症因此，这一研究项目将有助于刻画 骨骼表型和长期高血糖对三年期间骨骼变化的影响；以及 因此，它将允许未来的临床试验，以改善骨骼健康和降低骨折风险的成年人 T1D。

Abstract People with type 1 diabetes (T1D) have a six- to eight-fold higher risk for hip fractures compared to people without diabetes. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. Moreover, hip fracture mortality is higher in patients with diabetes compared to subjects without diabetes. Dual x-ray absorptiometry (DXA), the most common test to assess bone health, underestimates fracture risk in patients with T1D. Altered geometry in young-onset T1D (T1D diagnosis before age 20), and reduced bone mechanical and material qualities are implicated in bone fragility in T1D. Chronic hyper- and hypoglycemia is postulated to suppress bone turnover leading to accumulation of microdamage and advanced glycation endproducts (AGE) resulting in compromised bone material properties in T1D. Despite higher fracture risk, the effect of T1D on bone structural and material properties and diabetes-related factors affecting bone health are unknown. Considering the knowledge gap, we propose to evaluate baseline skeletal phenotype using validated quantitative computed tomography (QCT), finite element (FE) based bone strength, and OsteoProbe®- measured in vivo bone material strength index (BMSi), and changes in these measures over 3 years in a large cohort of adults with and without T1D from the ongoing ‘Coronary Artery Calcification in Type 1 Diabetes’ (CACTI) study. We will also determine the role of acute hyper- and hypoglycemia on bone turnover and its long-term impact on bone material properties. With improved care, people with T1D are living longer and there is no specific approach for prevention and treatment of osteoporosis for older adults with T1D. Therefore, this research project will help to characterize bone phenotype and the effect of long-term hyperglycemia on bone changes over a period of three years; and therefore, it will allow for future clinical trials to improve bone health and reduce facture risk among adults with T1D.