Individuals with type 1 diabetes have over a sixfold increased risk of sustaining a hip fracture compared to the general population. Despite this, bone fragility is not recognized as a classic diabetes-related complication and many diabetes guidelines make no mention of fracture prevention or bone health.
We studied bone health in a population of patients with known type 1 diabetes being followed by endocrinologists at an academic centre. Patients filled out a bone health questionnaire which was used to up-date their electronic medical record (EMR). De-identified data was extracted from the EMR for all type 1 patients over age 40. Fracture risk scores were calculated using the WHO fracture risk assessment tool (FRAX). The study was approved by the Local Research Ethics Board.
There were 201 individuals identified, with mean age of 53.9 years (4082). Of these, 7 (3.5%) were identified as high risk for future fracture by their calculated FRAX score (>20% risk of major osteoporotic fracture over the next 10 years), and 18 (8.9%) were in the moderate risk category (1020% risk). Despite our current national osteoporosis guidelines to treat all high risk patients, and to consider treatment of moderate risk patients, 2 of 7 (28.5%) high risk patients were not on therapy with an osteoporosis-specific medication and 14.3% were not on calcium or vitamin D. Of the moderate risk patients, 17 of 18 (94.4%) were not on bone-specific therapy and 38.9% were not taking calcium or vitamin D.
Our results identify a care gap for treatment of osteoporosis in patients with type 1 diabetes followed at an academic centre. This care gap is expected to be worse in non-specialty centres, with less time for comprehensive diabetes management, and highlights the need to up-date diabetes care guidelines to include bone fragility as a complication of type 1 diabetes.
17 May 2014 - 20 May 2014