%0 Journal Article
%T Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed
%A Volha V. Zhukouskaya
%A Alla P. Shepelkevich
%A Iacopo Chiodini
%J Advances in Endocrinology
%D 2014
%R 10.1155/2014/982129
%X 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. 1. Introduction Type 1 diabetes (T1D) is an autoimmune disease that precipitates in genetically susceptible individuals by environmental factors. The body¡¯s own immune system attacks the beta-cells in the islets of Langerhans of the pancreas, destroying or damaging them sufficiently to reduce and eliminate insulin production, leading to the hypoinsulinemia and chronic hyperglycaemia [1]. T1D incidence has been globally rising during the past decades by as much as 3% annually, the cause of which is unknown. If these trends will continue, the total prevalence of people with type 1 diabetes will increase in coming years [2]. Chronic hyperglycaemia in T1D leads, in course of time, to chronic complications. Besides acute diabetic complications, nowadays, health providers give more attention to the prevention of disabling chronic complications, such as diabetic retinopathy, nephropathy, neuropathy, and precocious atherosclerosis with early cardiovascular disease. Recently, a major interest has been focused on poor bone metabolism in T1D that can represent an overlooked complication of diabetes. 2. What Do We Know? Bone Parameters and Fracture Risk in Type 1
%U http://www.hindawi.com/journals/aen/2014/982129/