Supervisor: Prof. Morten Frost
Co-supervisors: Prof. Andrea Burden, Prof. Peter Vestergaard & Prof. Richard Eastell
PhD Project Title: Epidemiology of fragility fractures and diabetes
Brief summary: The association between diabetes and fragility fractures is an evolving research area. Type 1 diabetes (T1D) debuts in children and young adults and type 2 diabetes (T2D) is most commonly diagnosed in adulthood. By contrast, fragility fractures are observed in the elderly. Importantly, several diseases and therapies may impair bone strength and increase fracture risk. Indeed, low bone mineral density (BMD) and increased fracture rates were observed in patients with T1D in young and middle- aged adults. On the other hand, although patients with T2D have normal or even increased bone mass, the disease associates with a moderately increased risk of fragility fractures. Thus, fragility fractures in T1D and T2D are not fully explained by classical age-related osteoporosis. Much-debated questions regarding the effect of multiple diabetes-related factors on skeletal fragility, including microvascular disease, medications and insulin sensitivity and secretion, remain unanswered.
Research Objective:
- To obtain a detailed epidemiology of fragility fractures in T1D and T2D
- To determine whether microvascular disease predicts fragility fractures in patients with T1D and T2D
- To investigate if insulin sensitivity and secretion predict fractures in patients with T2D
- To determine fracture risk in clinical trials investigating effects of treatment of T2D, including assessing if treatments convey different effects on fracture risk
Perspective: The research is a step forward towards a better understanding of diabetic skeletal fragility, thus clarifying if fracture risk increases earlier and prevention strategies need to be initiated earlier in T1D as compared to T2D and the general population. Besides, the project will help elucidate the ambiguity of the impact of microvascular diseases and antidiabetic medications on fragility fracture risk. Thus, a better clinical management, improved preventive efforts, and increase focus on individually targeted treatments to be implemented, for an improved care of diabetes patients.
