PREVALENCE AND MAGNITUDE OF OSTEOPENIA ASSOCIATED WITH INSULIN-DEPENDENT DIABETES-MELLITUS

The authors evaluated the prevalence, magnitude, and contributing fact ors for osteopenia in insulin-dependent diabetes mellitus (IDDM). We m easured bone mineral density (BMD) in the lumbar spine and femoral reg ion in 90 patients aged 18-54 years with IDDM using dual-energy x-ray absorptiometry. The blood-glucose control, insulin dosage, duration of disease, and presence of chronic complications of diabetes were evalu ated. Serum ionized calcium, magnesium, phosphorus, alkaline phosphata se (ALP), 25-hydroxycholecalciferol, immunoreactive parathyroid hormon e (iPTH), and urinary calcium, phosphorus, and hydroxyproline were als o analyzed. Thirty-one patients (34%) were classified as having a redu ced BMD (less than 2 SD below the mean). The comparison between normal and low BMD patients showed that the osteopenics had a tendency to be younger (median, 28 years versus 32 years), showed a higher mean plas ma glucose (15.5 +/- 5.0 mmol/L versus 12.9 +/- 3.8 mmol/L; p = 0.018) , longer duration of disease (11.2 +/- 2.1 years versus 5.0 +/- 1.3 ye ars; p = 0.004), and needed a higher insulin dosage (56 +/- 17} U/day versus 43 +/- 16 U/day; p < 0.001). There was a positive correlation b etween mean glucose levels, duration of disease, insulin dosage, and b one-mass decrease. A higher incidence of chronic complications, mainly retinopathy (58% versus 25%) and neuropathy (52% versus 22%) was foun d in the low BMD group. There was no alteration of serum calcium, phos phorus, iPTH, 25-hydroxycholecalciferol, and urinary calcium and phosp horus. The ALP levels were significantly higher in the osteopenic grou p, and magnesium and hydroxyproline levels were lower in the whole dia betic group, but these measurements did not correlate with BMD reducti on. Osteopenia should be considered as a chronic complication of poorl y controlled patients, and is associated with longer disease duration and other IDDM chronic complications. (Journal of Diabetes and Its Com plications 8;2:97-104, 1994.)