Bone remodeling parameters in patients with type 1 diabetes mellitus and diabetic peripheral polyneuropathy of varying severity

BACKGROUND: Diabetic peripheral polyneuropathy (DPPN) is a common and early chronic complication of diabetes mellitus (DM). This complication can be associated with bone tissue damage and low-trauma fractures, particularly in type 1 DM. Therefore, evaluating the relationship between DPPN and bone metabolism parameters is crucial for clinical practice.

AIM: To assess bone remodeling parameters in patients with type 1 DM with varying degrees of DPPN.

MATERIALS AND METHODS: The study included 90 patients with type 1 DM and DPPN aged 18 to 55 years on stable insulin therapy for the past 3 months. Assessment was conducted for levels of HbA_1c, 25(OH)D, total calcium (Ca), phosphorus (P), parathyroid hormone (PTH), osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), fibroblast growth factor 23 (FGF-23) in serum. The degree of neurological deficit was determined using the Neuropathy Disability Score (NDS), Neuropathy Symptoms Score (NSS), and Michigan Neuropathy Screening Instrument (MNSI). Dual-energy X-ray absorptiometry (DXA) was performed to determine bone mineral density (BMD) and trabecular bone score (TBS).

RESULTS: Regardless of the degree of DPPN severity, patients with type 1 DM were comparable in HbA_1c and 25(OH)D levels. A direct correlation was found between the severity of neurological disorders and BMI (r=0.214; p=0.044) and duration of DM (r=0.246, p=0.019). Vitamin D insufficiency and deficiency were diagnosed in 79% of examined patients with type 1 DM, but the level of 25(OH)D in serum did not depend on the degree of DPPN severity, HbA_1c level, duration of DM, and daily insulin dose (p>0.05). A positive correlation was established between PTH level and severity of neurological symptoms, and a ­negative one with HbA_1c level. Patients with type 1 DM and varying degrees of DPPN did not differ in BMD and TBS. A Z-score of less than -2.0 SD was only recorded in six patients, and partially degraded microarchitecture of bone tissue was observed in 8 patients.

CONCLUSION: Therefore, BMD, TBS, and bone remodeling markers in patients with type 1 DM and DPPN were independent of the degree of neurological deficit, degree of compensation, and duration of DM. Vitamin D deficiency is common in most patients with type 1 DM, but the 25(OH)D level is not influenced by HbA1c level, duration of the disease, and daily insulin dose.

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