Contributions of bone microarchitecture to skeletal fragility in adults with longstanding type 1 diabetes
Authors' conclusion
The minor differences in bone microarchitecture observed in this study may partly contribute to the increased fracture risk among patients with T1D, though more research examining mediating factors both intrinsic and extrinsic to bone is needed.
Study context
- Population
- Adults aged >50 years with longstanding T1D and individuals without diabetes
- Participants
- 96 vs 57
- Exposure
- Adults with longstanding T1D vs individuals without diabetes
- T1Dn = 96
- Controlsn = 57reference
- Outcome
- Bone microarchitecture and estimated bone strength (aBMD by DXA, TBS, HR-pQCT volumetric BMD (vBMD), microarchitecture and estimated failure load at distal radius and tibia)
Main finding
As reported in the abstract
Bone density, microarchitecture and estimated strength
- Areal BMD (aBMD) and trabecular bone score (TBS) did not differ between groups after adjusting for age, sex, height and weight
- High-resolution peripheral quantitative computed tomography (HR-pQCT): modest cortical deficits in T1D, largely preserved trabecular microarchitecture
- No significant difference in estimated failure load vs controls
Observational data: associations, not effects.
Further findings
Prior history of fracture (self-reported)
P < 0.001
Within T1D: prior fracture
- Those with prior fracture had lower spine aBMD and lower estimated strength at the tibia
Within T1D: diagnosis at or before age 12 years vs later
- Worse trabecular parameters at the radius with diagnosis at ≤12 years; no differences at the tibia or on DXA
Retinopathy
- Retinopathy associated with lower aBMD at hip and femoral neck and lower trabecular thickness, area, failure load and stiffness at the tibia
Original publication
Contributions of bone microarchitecture to skeletal fragility in adults with longstanding type 1 diabetes. J Bone Miner Res. Published 23 March 2026. doi:10.
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