Oral Presentation ESA-SRB-AOTA 2019

Associations between reproductive factors and bone health outcomes in women with diabetes: a 15-year longitudinal study (#128)

Eleanor P Thong 1 2 , Frances Milat 1 3 , Anju E Joham 1 2 , Sanjeeva Ranasinha 2 , Peter R Ebeling 1 4 , Gita D Mishra 5 , Helena Teede 1 2
  1. Dept of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
  2. Monash Centre for Health Research & Implementation, Melbourne, VIC, Australia
  3. Hudson Institute of Medical Research, Clayton, VIC, Australia
  4. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
  5. Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, St Lucia, QLD, Australia

Aims: To evaluate associations between reproductive health with incident fracture and new osteoporosis diagnosis in women with self-reported type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with controls.

Methods: Longitudinal observational study using data from the Australian Longitudinal Study in Women’s Health (ALSWH). Women aged 45 to 50 years were followed up every three years, for up to 15 years.

Outcomes: Self-reported fracture and osteoporosis diagnosis.  

Statistical analyses: Poisson regression analyses for evaluation of incidence rate ratios for fracture and osteoporosis, and multiple linear regression analyses for evaluation of associations between time-to-fracture/osteoporosis between diabetes types.

Results: 107 women with T1D, 1232 with T2D and 10874 controls were included. 1260 incident fractures and 1085 new cases of osteoporosis occurred over 165357 person-years of follow-up. Mean age at baseline was 47 years in all groups. Women in the T1D group had lower mean BMI, (25.5±4.9 vs. 27.6±6.3 vs. 25.8±5.0 kg/m2, p<0.001) and reduced reproductive lifespan (period between menarche and menopause) compared with the T2D and control groups [34.7±3.8 vs. 37.4±4.8 vs. 37.4±4.0 years, p<0.001]. Age of natural menopause was significantly lower in T1D (47.7±3.4 vs. 50.1± 4.5 vs. 50.3±3.7, p<0.001). Neither T1D nor T2D were associated with incident fracture, although osteoporosis incidence was significantly higher in T1D and T2D, compared with controls (T1D: IRR 1.86, 95%CI 1.02–3.39; T2D: IRR 1.33, 95%CI 1.04–1.70). T1D status was independently associated with a two- and five-year earlier onset of fracture and osteoporosis diagnosis, respectively (fracture: ß -2.04 years, p=0.004; osteoporosis: ß -4.91 years, p<0.001).

Conclusions: Women with T1D have a reduced reproductive lifespan and shorter time to fracture and osteoporosis, compared with both T2D and controls. Diabetes is associated with osteoporosis, and this work confirms the need for consideration of bone health assessment in diabetes, especially around the midlife transition.