Diabetes-Brittle Bones Link Underscores Need for Earlier Education About Osteoporosis

BUFFALO, N.Y. -- The importance of educating women who have type 1 diabetes about osteoporosis at a much earlier age is underscored by preliminary data from research at the University at Buffalo showing that diabetes and brittle bones may go hand in hand.

"This kind of education should happen in a young woman's life, in the school and in the pediatrician's office because those are very critical years to form lifestyle habits that will help you preserve your bones down the road," says Teresa Quattrin.

Associate professor of pediatrics in the UB School of Medicine and Biomedical Science and director of the Diabetes Center at Children's Hospital of Buffalo, Quattrin is lead investigator on a study that seeks to establish a possible link between women diagnosed with type 1 (insulin dependent) diabetes and the early onset of osteoporosis. It's estimated that osteoporosis affects nearly 10 million Americans, about 8 million of whom are women.

With funding from an American Diabetes Association Clinical Research Award, Quattrin initially undertook a cross-sectional, bone-mineral density study -- that since has expanded into a much larger, longitudinal study -- to try and pinpoint when and why bone loss begins occurring in girls and young women.

"We wanted to see how women ages 13-19 were doing and wanted to see women in their 20s and 30s because one of the issues is that it (bone loss) seems to strike women before the classic symptoms of osteoporosis would. Ordinarily, you think of women getting this during the menopause years," says Quattrin.

The study may prove to be groundbreaking, she adds, because of the lack of definitive research on bone density loss in young people with type 1 diabetes.

As part of the cross-sectional study, bone-density scans were obtained from two groups of females ages 13-18 and 19-30 with type 1 diabetes; each subject also had a matched-age control. The scans showed that although type 1-study participants' bone density was within normal limits, it was lower than the bone density of those in the control group.

Quattrin hopes that the data obtained from both studies, along with a two-year follow-up scheduled for all participants, will give researchers the tools to develop preventive measures relative to the needs of young women with type 1 diabetes.

The second component of the study examined blood and urine levels of such hormones as osteocalcin, estrogen and insulin -- all of which play an important role in the formation of healthy bone -- and N-telopeptides, a marker of bone resorption.

Quattrin says that although preliminary data have not yet established a relationship between key hormones related to bone-mineral density, it is well-established that obese people who produce excessive insulin tend to have higher bone-mineral density, while the opposite is true for people with lower insulin levels. This, she says, provides the conceptual link between insulin and bone density.

One thing is certain: Young girls need to reach peak bone-mineral density quickly, before maturity if possible. There is only about a two-year window of opportunity after the onset of menstruation in which most young women experience increases in bone density, says Quattrin

"If you are 25 and have a low bone-mineral density, it's not likely that you're going to increase it," she adds.

Moreover, there is power in knowing one's family history because bone-mineral density is "highly genetically determined," according to Quattrin. "Many women would know exactly if their mothers had something bad like cancer of the uterus, but they may not pay any attention to the fact that their moms might have been having bone loss in earlier years," she says.

Other important factors determining healthy bone formation are such lifestyle issues as diet, weight, smoking and exercise, and the use of hormonal preparations like estrogen, which actually may increase bone-mineral density. Quattrin also emphasized that the patient's relationship with her team of physicians and caregiver is vital to making any treatment protocol a success.

While the public-at-large is much more educated about the importance of bone strength, the focus remains on middle-aged and pre-menopausal women, she adds.

"It's a 'funny joke' when people tell you 'I shrunk; I used to be 5' 4" and now I'm 5'3," but it's not a joke," Quattrin says, pointing out that spinal measurements of middle-aged people show significant decreases in bone density that often go undetected until a problem occurs, such as a fracture from a fall.

Other UB researchers on the study are Jean Wactawski-Wende, assistant professor of gynecology and obstetrics; Richard P. Donahue, professor of social and preventive medicine, and Jacek Dmochowski, assistant professor of statistics, and their participation underscores, according to Quattrin, an "exciting (cross-disciplinary) collaboration."