Middle-Aged Premenopausal Women With Type 1 Diabetes Have Lower Bone Mineral Density and Calcaneal Quantitative Ultrasound Than Nondiabetic Women

  1. Elsa S. Strotmeyer, PHD1,
  2. Jane A. Cauley, DRPH1,
  3. Trevor J. Orchard, MD1,
  4. Ann R. Steenkiste, MS2 and
  5. Janice S. Dorman, PHD2
  1. 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  2. 2Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
  1. Address correspondence and reprint requests to Elsa S. Strotmeyer, PhD, MPH, Department of Epidemiology, University of Pittsburgh, 130 North Bellefield Ave., Room 519, Pittsburgh, PA 15213. E-mail: strotmeyere{at}edc.pitt.edu


OBJECTIVE—To determine whether middle-aged premenopausal women with type 1 diabetes had more self-reported fractures and lower bone mineral density (BMD) compared with nondiabetic women.

RESEARCH DESIGN AND METHODS—Participants were premenopausal women aged 35–55 years with type 1 diabetes (n = 67; 32.2 ± 5.3 years duration) and without diabetes (n = 237). Total hip, femoral neck, whole-body, and spine BMD were measured by dual X-ray absorptiometry. Calcaneal broadband ultrasound attenuation (BUA) was assessed with quantitative ultrasound.

RESULTS—Women with type 1 diabetes were more likely to report a fracture after age 20 years compared with nondiabetic women (33.3 vs. 22.6%; age-adjusted odds ratio 1.89 [95% CI 1.02–3.49]). Type 1 diabetes was associated with lower total hip BMD (0.890 vs. 0.961 g/cm2; P < 0.001), femoral neck BMD (0.797 vs. 0.847 g/cm2; P = 0.001), whole-body BMD (1.132 vs. 1.165 g/cm2; P < 0.01), and lower calcaneal BUA (71.6 vs. 84.9 dB/MHz; P < 0.001) after multivariate adjustment. BMD was 3–8% lower in type 1 diabetic compared with control women and calcaneal BUA was 15% lower. Spine BMD and biomarkers of bone remodeling were not significantly different between groups. In the type 1 diabetic women, reduced monofilament detection and blindness were both associated with lower BMD.

CONCLUSIONS—Lower BMD in premenopausal women with type 1 diabetes may substantially increase their risk of developing osteoporosis after menopause. Type 1 diabetic women should be targeted for osteoporosis screening and possible fracture prevention as they transition through menopause.


  • J.A.C. has received honoraria from Eli Lilly, Merck, and Novartis and grant/research support from Eli Lilly, Merck, Pfizer, and Novartis.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 11, 2005.
    • Received July 21, 2005.
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