Type 1 and Osteopenia/Osteoporosis

I am new to this site and frankly, have never posted in a “chat room” before now. However, I’ve decided to do so as I am interested in others’ information on this topic.

First, my background. I am a T1DM of 37 years, diagnosed at age 15. For better or worse, being a “type A” personality I guess, I’ve always been motivated to attempt to keep myself in “good” control with HBA1cs in the normal or near normal range. I just hate the idea of letting diabetes “win” by shortening my life. I was originally cared for by an excellent internist whose entire practice was type 1 and 2 diabetics. He was well trained and well read, and I was motivated, so we partnered together to manage my diabetes through high school, college, living overseas, early adulthood and traveling around the world (as a student). Together we moved me from two injections daily, to the first insulin pump available in 1981 (Autosyringe), and then to MDI. We went from urine testing to BG testing, from a single BG test to monitoring my glycohemoglobin. In the end, he set me on path that has allowed me to “win” over my t1dm thus far. That being said, there are some “complications” that do not appear to be BG control related and that includes osteopenia/osteoporosis. I was found to have osteopenia before I was postmenopausal and started a bisphosphonate. I am now 18 months postmenopausal and have osteopenia and some osteoporosis. While I also have Hashimoto’s thyroiditis, my thyroid is pretty well controlled on Synthroid. I am not hyperthyroid which would tend to increase the resorption of bone …thinning my bones. My endo tells me the osteoporosis is linked to my type 1.

I have not yet been out to PubMed to determine who is doing research on T1DM and osteoporosis although I do know there is some going on, based on a profile I saw in the ADA magazine. If anyone knows of work going on in the country, please let me know. Not all of us will have this challenge so the researchers may be looking for those of us that do …making the patient population small and hard to find for research. So, I’d like to get involved. Thanks, in advance, for any guidance you can provide. This is an area that is not yet well understood and needs greater focus for all of us Type 1s …men and women alike!

I have had T1D since age 2, 38 years now. I haven’t heard of the connection between T1D and osteopenia nor osteoporosis, but they always seem to say ‘higher incidence rate’ to just about everything and T1D.

I do have Grave’s Disease and low Vitamin D (so take 2000 IU daily). I also had two frozen shoulders. None of these really appear on the “complications” list of T1D but they tell me all are connected to T1D and have nothing to do with control.

Thanks for posting. Let us know if you find anything else out about the link between T1D and osteoporosis.

Thanks, Katie. I will post what I learn about the connection but I believe I’m going to have to do some digging. Here is all that I know:

I spoke with an expert recently who shared that the current literature does not do a good job with this topic because most studies have been done in poorly controlled diabetics (not sure if that is type 1 or type 2) …not in individuals who have normal or close to normal HBA1cs. So the blood sugar levels create a confounding variable in the data. Based on what he shared with me, my understanding is as follows: Apparently natural insulin (from one’s pancreas) is anabolic for bone (re: helps to make bone via the osteoclasts). Unfortunately, it appears that when we inject insulin, it does not have the same action. (I don’t know why though.) Thus, we don’t get the same bone building action of natural insulin.

The other issue is that apparently frequent hypoglycemic episodes are also not good for bone formation as they induce the release of adrenalin which affects both collagen and bone. For me, this was important information as I tend to experience more lows than highs in my daily effort to control my disease. Lows for me are still detectable and therefore, easier to correct.

I hope this is helpful.
From “Sweet & Tough”

IMPORTANT NOTE: These comments are just my understanding and I am not a physician. If anyone reading this needs guidance on his/her own situation, I recommend you should speak to your endocrinologist or a rheumatologist. I am just sharing what I have learned to enable all of us to have more informed discussions with our physicians and perhaps, encourage greater research in this area.

I just a key article in Clinical Diabetes from way back in 2004.
This link should get you to it: http://clinical.diabetesjournals.org/content/22/1/10.full.pdf+html
It is called: Osteoporosis: An Under-appreciated Complication of Diabetes.
Authors: Sue A. Brown MD and Julie Sharpless, MD. At the time they were at University of North Carolina.

As the article is 10 years old, I will need to continue digging for more recent information and will post for those who are interested.