The Risk factors for Osteoporosis and Falls, their Association, and Knowledge in Patients with Type 1 Diabetes Mellitus
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Date
2023-12
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Addis Ababa University
Abstract
Background: Patients with type 1 diabetes have a lower bone mineral density (BMD) and up to
6-fold higher risk of fracture compared to healthy subjects, justifying the classification of the
disease as a non-modifiable risk factor for osteoporosis. The literature describes a variety of risk
factors for low BMD in patients with type 1 diabetes, with some conflicting evidence. Data on
osteoporosis and related factors in patients with type 1 diabetes in Ethiopia, Africa, and other low-
and middle-income countries is lacking.
Objectives: To determine the risk factors for osteoporosis and falls, their association, and
knowledge in patients with Type 1 Diabetes age 40 years and above.
Methods: An institution-based cross-sectional study was conducted from June 1 to August 31,
2023GC at the diabetes clinic in Tikur Anbessa Specialized Hospital, Addis Ababa. All patients
with Type 1 diabetes age 40 years and above attending the diabetes clinic during 2023GC were
enrolled. Data was collected through pretested structured interviewer-administered questionna ires
and analyzed using SPSS version 26. The statistical association was tested using Pearson's
correlation coefficient, chi-square test, bivariate and multivariable logistic regression. Statistica l
significance was considered at a level of significance of 5%, and an adjusted odds ratio (AOR)
with a 95% confidence interval (CI) was used to present the estimates of the strength of the
association. Finally, outcomes were presented with tables, figures, and statements.
Results: This study involved a total of 106 participants of which 54.7% were males and 47.2%
were between the ages of 40-44 years. Ninety-six percent of the study participants were living with
Diabetes for more than 10 years and two-thirds had persistent proteinuria. Fifty-two percent had
diabetic eye complications, 10.4% had an eGFR of <60ml/min/1.73m2 while 9.4% of the
participants consumed more than three units of alcohol per day. Only two participants had a high
FRAX fracture risk score but 13.2% had a history of previous fragility fracture. Age and duration
of diabetes had a positive correlation and eGFR had a negative one with the 10-year probability of
a major osteoporosis-related and hip fracture. The magnitude of osteoporosis was 15%. Fifteen
percent of the study participants had frequent falls and 13.2% had a high concern of falling. Being
female (AOR=1.6, 95% CI=1.42, 5.88), having previous fragility fractures (AOR=1.8, 95%
CI=1.04, 9.27), and osteoporosis (AOR=4.1, 95% CI=1.15, 16.49) were associated with frequent
falls. Eighty-three percent had poor knowledge about osteoporosis with a higher level of education
associated with a higher level of osteoporosis knowledge. The factors associated with osteoporosis
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were female gender (AOR=1.8, 95% CI=1.41, 7.69), excess alcohol use (AOR=5.7, 95% CI=1.69,
47.38), diabetic eye complications (AOR=4.7, 95% CI=1.91, 24.35), and frequent falls (AOR=5.6,
95% CI=1.19, 26.15).
Conclusion: Type 1 diabetes carries an increased risk of osteoporosis, falls, and fractures. Being
female, having previous fragility fractures and osteoporosis had a positive association with
frequent falls, whereas being female, excess alcohol use, diabetic eye complications, and frequent
falls were independent determinants of osteoporosis. A significant osteoporosis knowledge deficit
was also seen among the participants with a higher level of education being positively associated.
A high concern of falling with difficulties maintaining balance were other concerning outcomes.
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Keywords
Type 1 Diabetes, Osteoporosis, Falls, FRAX, Osteoporosis knowledge