Table of Contents
Advances in Endocrinology
Volume 2014, Article ID 982129, 12 pages
http://dx.doi.org/10.1155/2014/982129
Review Article

Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed

1Department of Clinical Sciences and Community Health, University of Milan, Unit of Endocrinology and Metabolic Disease, Foundation IRCCS Cà Granda, Ospedale Maggiore Policlinico, Padiglione Granelli, F. Sforza Street, No. 35, 20122 Milan, Italy
2Belarusian State Medical University, Dzerzinski Avenue, No. 83, 220116 Minsk, Belarus

Received 16 January 2014; Accepted 30 May 2014; Published 25 June 2014

Academic Editor: Qing-Sheng Mi

Copyright © 2014 Volha V. Zhukouskaya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D.