Bone mineral density and the risk of kidney disease in patients with type 1 diabetes

Sabina Chaudhary Hauge; Henrik Øder Hjortkjær; Frederik Persson; Simone Theilade; Morten Frost; Niklas Rye Jørgensen; Peter Rossing; Ditte Hansen

doi:10.1016/j.jdiacomp.2024.108927

Bone mineral density and the risk of kidney disease in patients with type 1 diabetes

J Diabetes Complications. 2024 Dec 5;39(2):108927. doi: 10.1016/j.jdiacomp.2024.108927. Online ahead of print.

Authors

Sabina Chaudhary Hauge¹, Henrik Øder Hjortkjær², Frederik Persson², Simone Theilade², Morten Frost³, Niklas Rye Jørgensen⁴, Peter Rossing⁵, Ditte Hansen⁶

Affiliations

¹ Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark. Electronic address: sabina.chaudhary.hauge@regionh.dk.
² Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
³ Molecular Endocrinology Laboratory (KMEB), Odense University Hospital, J.B. Winsløws Vej 25, 1, Floor, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
⁴ Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 13, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Translational Research Center, Nordstjernevej 42, 2600 Glostrup, Denmark.
⁵ Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
⁶ Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.

PMID: 39708433
DOI: 10.1016/j.jdiacomp.2024.108927

Abstract

Aim: To explore the association between bone disorder and the risk for progression of diabetic kidney disease (DKD) in persons with type 1 diabetes mellitus (T1DM).

Methods: In this prospective cohort study the association between bone mineral density (BMD), bone-derived factors (sclerostin, Dickkopf-1, and osteoprotegerin (OPG)), and four outcomes were investigated: 1) progression of albuminuria; 2) decline in estimated glomerular filtration rate (eGFR) ≥30 %; 3) kidney failure (KF); and 4) a composite kidney outcome consisting of at least one of the outcomes.

Results: In 318 participants (median follow-up time 5.5 years) patients with osteoporosis (BMD with T-score < -2.5) had increased risk of eGFR decline: hazard ratio (HR) 2.56 (95 % CI 1.06-6.19, p = 0.04), KF: HR 9.92 (95 % CI 1.16-84.95, p = 0.04), and the composite kidney outcome: HR 2.42 (95 % CI 1.18-4.96, p = 0.02). Patients with high OPG had increased risk of eGFR decline, KF, and the composite outcome, compared to patients with low OPG in unadjusted analysis. No bone-derived factor was associated with any outcome in adjusted analyses.

Conclusions: In patients with T1DM low BMD was associated with progression of DKD, suggesting an interaction between bone and kidney.

Keywords: Bone mineral density; Chronic kidney disease; Dickkopf-1; Osteoprotegerin; Sclerostin; Type 1 diabetes.