How Type 1 Diabetes affects Bone Health

Type 1 diabetes mellitus is an autoimmune disorder marked by the destruction of pancreatic islet cells, resulting in an absolute deficiency of insulin. Multiple mechanisms have been recognized to explain the skeletal fragility observed in T1DM, including reductions in bone mineral density (BMD), alterations in bone geometry, impaired bone microarchitecture, and compromised biomechanical properties, as evidenced in both humans and animal models of T1DM. Previous meta-analyses have shown that individuals with T1DM face a four- to sevenfold higher risk of hip fractures compared to controls (1, 2).

How Type 1 Diabetes affects Bone Health

In a recent cross-sectional clinical study researchers explored the differences in bone turnover markers (BTMs) and their correlations with areal mineral density (aBMD) in people with type 1 diabetes (T1D), to gain deeper insights into the mechanisms of skeletal fragility, including differences related to sex and hormonal factors (3).

Both the Biomedica BIOACTIVE SCLEROSTIN ELISA Assay and the FGF23 INTACT ELISA Assay were featured in this study.  

Bioactive Sclerostin ELISA (cat. no. BI-20472)

• Characterized antibodies that target the Sclerostin receptor binding region
• The assay is  validated for clinical samples  (validation data file)
• Only  20µl sample /well (protocol booklet)
• Widely cited

 

 FGF23 intact ELISA (cat. no. BI-20700)

• Extensively validated according to international quality guidelines
• Correlates with existing methods (validation data file)
• One-step ELISA  (protocol booklet)
• Cited in top-tier journals

 

Bone turnover markers and mineral density in type 1 diabetes – A cross-sectional study: DIAFALL. Rasmussen NH et al., Bone. 2025.

Abstract

Introduction/aim: This study investigated differences in bone turnover markers (BTMs) and their associations with areal bone mineral density (aBMD) in people with type 1 diabetes (T1D) to better understand the mechanisms underlying skeletal fragility, including sex- and hormone-related variations.

Methods: A cohort of 110 Caucasian participants with T1D were matched 1: 1 with age- and sex-matched controls. aBMD at the lumbar spine, femoral neck, legs, and arms was assessed using DXA. BTMs included P1NP, osteocalcin (OC), sclerostin, CTX-1, TRAcP, IGF-1, BASP, and osteopontin (OPN). Group comparisons were conducted using t-tests, and associations between BTMs and aBMD were examined using regression and Spearman correlations. Exploratory subgroup analyses stratified women by menopausal status.

Results: Bone formation markers (P1NP, OC) were significantly lower in T1D men compared to controls (P1NP: p = 0.046; OC: p = 0.002), reflecting suppressed bone formation. IGF-1 was reduced in both sexes (p < 0.001) and correlated positively with aBMD in women (p < 0.05), but not in men. Sclerostin levels were elevated in both sexes (p = 0.002-<0.001) without correlating with aBMD. CTX-1 was reduced in T1D men (p = 0.004), while TRAcP was elevated in both sexes (p = 0.044), correlating negatively with aBMD in women. Men with T1D had significantly lower leg aBMD (p = 0.032) and reduced femoral neck bone mineral content (p = 0.041). No overall differences were observed among women; however, exploratory analyses revealed that postmenopausal women with T1D had higher TRAcP and sclerostin levels and lower femoral neck aBMD compared to premenopausal counterparts.

Conclusion: T1D was associated with significant alterations in certain BTMs and reduced aBMD in men, while skeletal effects in women appeared to be influenced by menopausal status. The weak and mostly non-significant correlations between BTMs and aBMD suggest that impaired bone quality, rather than bone mass alone, may be the primary driver of skeletal fragility in T1D. Hormonal status may further modify these effects in women.

 

Literature

1. Fracture risk in young and middle-aged adults with type 1 diabetes mellitus: A systematic review and meta-analysis. Thong EP, Herath M, Weber DR, Ranasinha S, Ebeling PR, Milat F, Teede H. Clin Endocrinol (Oxf). 2018 Sep;89(3):314-323. doi: 10.1111/cen.13761. Epub 2018 Jul 3. PMID: 29876960; PMCID: PMC6105385.
2. Bone fragility in diabetes: novel concepts and clinical implications. Hofbauer LC, Busse B, Eastell R, Ferrari S, Frost M, Müller R, Burden AM, Rivadeneira F, Napoli N, Rauner M. Lancet Diabetes Endocrinol. 2022 Mar;10(3):207-220. doi: 10.1016/S2213-8587(21)00347-8. Epub 2022 Jan 31. PMID: 35101185.
3. Bone turnover markers and mineral density in type 1 diabetes – A cross-sectional study: DIAFALL. Rasmussen NH, Kvist AV, Lykkeboe S, Starup-Linde J, Handberg A, van den Bergh JP, Vestergaard P. Bone. 2025