MICROALBUMINURIA AS AN EARLY INDICATOR OF OSTEOPENIA IN MALE INSULIN-DEPENDENT DIABETIC-PATIENTS

Reduced bone mineral density (BMD), termed diabetic osteopenia, has be en reported in patients with insulin-dependent (Type 1) diabetes melli tus (IDDM). To examine BMD in long-term IDDM patients with normal kidn ey function, but with different degrees of urinary albumin excretion r ate (UAER), compared to that of patients with elevated plasma creatini ne, 36 IDDM male patients (mean duration 27 years) were subdivided acc ording to UAER (<30, 30-300, >300, >300 mg 24 h(-1) and plasma creatin ine 0.120-0.350 mmol l(-1)) and 15 controls were recruited. BMD was me asured by dual energy X-ray absorptiometry and UAER by enzyme linked i mmunosorbent assay. BMD was normal in IDDM patients with normal UAER a nd reduced in the femoral neck, the trochanter major, and the Wards tr iangle in patients with increased UAER (p < 0.01, p < 0.05, p<0.02). B MD correlated to creatinine clearance in both cortical and cancellous bone sites (p < 0.001, p < 0.0001), and inversely to the levels of pla sma PTH (p < 0.0005). We conclude that BMD is normal in long-term IDDM male patients with normal kidney function and normal UAER and reduced in patients with increased UAER. Diabetic osteopenia seems to be a pr ogressive phenomenon related to diabetic nephropathy and associated wi th the decrease in creatinine clearance and with the resulting rise in plasma PTH. (C) 1997 by John Wiley & Sons, Ltd.