PROSPECTIVE BONE-MINERAL DENSITY EVALUATION IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

The bone mineral density (BMD) in patients with insulin-dependent diab etes mellitus (IDDM) was evaluated prospectively to assess the course of osteopenia in IDDM. We measured BMD in the lumbar spine, femoral re gion, and total body calcium in 23 patients aged 21-53 years with IDDM for 2.3 to 20 years using a dual energy X-ray absorptiometry. A secon d BMD measurement was done after 26.5 +/- 4.1 months in all patients. The blood glucose control, insulin dosage, and disease duration were a lso assessed. Eleven patients had osteopenia (1 Z-score below the mean values of normal gender-and age-matched individuals). These patients had a longer IDDM duration (8.6 +/- 5.1 years in osteopenics versus 4. 6 +/- 3.75 years in non-osteopenics; p = 0.03). The blood glucose cont rol and insulin dosage were not significantly different throughout the study. The mean spinal BMD was higher in the second evaluation in bot h osteopenics (0.91 +/- 0.12 g/cm(2) and 0.96 +/- 0.09 g/cm(2), p = 0. 035) and non-osteopenics (1.24 +/- 0.15 g/cm(2) and 1.29 +/- 0.16 g/cm (2); p = 0.02). In the end of the study, however, the osteopenic group persisted with lower subnormal BMD values than the non-osteopenic gro up (p < 0.001). The small BMD increment observed in the spine did not correlate with changes in the metabolic control or with IDDM duration, but occurred mainly in patients younger than 30 years old. There was no significant change in the femoral BMD or total body calcium. None o f the patients developed or significantly worsened the osteopenia. We conclude that diabetic osteopenia, despite being a complication of hig h prevalence in IDDM, seems to be non-progressive in the majority of p atients. In some patients, the spinal BMD increased during observation and may have been due to achievement of peak bone mass. (C) 1998 Else vier Science Inc.