Diabetic osteopathy in type 1 diabetics using insulin pump therapy

Diabetic osteopathy is diffuse bone involvement in diabetics. In clinical practice, it is confirmed by decreased bone mineral density (BMD). It was first described more than 80 years ago as radiological signs of bone growth retardation in diabetic children [1]. As a re­ sult of an increasing knowledge of the pathophysiology of bone metabolism, the past 20 years have witnessed better understanding of the mechanisms of bone involvement, especially in type 1 diabetics. However, their impact on the manifestation of diabetic osteopathy remains unclear. The association between diabetes and bone disease is complex, depending on the course and type of diabetes, its complications and other factors outside diabetes, such as age, menopause or hypogonadism. An important role is played by different pathogenesis of ty­ pe 1 and type 2 diabetes. In type 1 diabetes, low bone density is observed whereas type 2 diabetics' bone density is the same as or even higher than in non-diabetics. Recent meta-analyses have confirmed a higher risk of fractures in both type 1 and type 2 diabetes. The article is concerned with bone involvement in type 1 diabetes. In clinical practice, this condition is frequently neglected due to other, more serious complications of diabetes. The aim was not to provide a comprehensive overview of pathophysiological and epi­ demiological data for diabetic osteopathy. A group of 34 young type 1 diabetics treated with insulin pump therapy were examined to prove the positive effect of regular meta­ bolic check-ups on BMD, as compared with non-diabetics of the same age, and to assess the correlation between type 1 diabetes dura­ tion and BMD as well as between HbA1c and BMD. Type 1 diabetics had lower BMD in the proximal femoral region including the neck. The difference in BMD was also related to BMI (p< 0.05). There was no effect

Keywords: bone density and quality, type 1 diabetes, insulin, boneformation, vitamin D