Bone Mineral Density and Vertebral Fracture Frequency in a Group of Type 1 Diabetic Patients
TL;DR
Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls, suggesting a potential role of phosphate metabolism in diabetic bone fragility.
Abstract
Objective: This study aimed to evaluate the relationship between vertebral fracture and various biological factors in patients with type 1 diabetes mellitus (T1DM). Methods: The study included 61 patients diagnosed with T1DM who were evaluated in the Diabetes Outpatient Clinic between 2017 and 2019, and 49 healthy individuals forming the control group. Demographic and clinical characteristics (age, gender, hypertension, hyperlipidemia, obesity), biochemical parameters (fasting blood glucose, HbA1c, calcium, phosphate, parathyroid hormone, 25-OH vitamin D, C-terminal telopeptide, osteocalcin, alkaline phosphatase), and bone-related variables (L1–L4 and femoral neck bone mineral density [BMD], vertebral fracture status) were comprehensively collected during outpatient visits. Vertebral fractures were assessed by the Genant semi-quantitative method using lateral vertebral fracture assessment images obtained by dual-energy X-ray absorptiometry. Data were analyzed using non-parametric statistical tests and expressed as median (interquartile range). Logistic regression analysis adjusted for age, sex, body mass index (BMI), and phosphate levels was performed. Results: Vertebral fracture prevalence was significantly higher in T1DM patients (67.2%) compared with controls (26.5%, P < .001). Patients had significantly lower body weight and BMI and higher rates of hyperlipidemia. Femoral neck BMD was significantly lower in the T1DM group (0.967 vs. 1.193 g/cm2, P < .001). Among diabetic patients, those with vertebral fractures had significantly lower serum phosphate levels than those without fractures (3.20 vs. 3.85 mg/dL, P = .008). No significant differences were observed in bone turnover markers or BMD values between patients with and without fractures. Conclusion: Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls. Lower phosphate levels were observed in patients with fractures, suggesting a potential role of phosphate metabolism in diabetic bone fragility. Cite this article as: Günhan HG, .etin O, İmre E, Gogas Yavuz D. Bone mineral density and vertebral fracture frequency in a group of type 1 diabetic patients. Cerrahpaşa Med J. 2026, 50, 0091, doi: 10.5152/cjm.2026.25091.