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Viral Shah, MD

Understanding the Association Between Bone and Heart Health in Postmenopausal Women With Type 1 Diabetes


Type 1 diabetes (T1D) is an autoimmune disease requiring lifelong insulin treatment. Having T1D increases the risk of death, especially in women with T1D.

Heart disease and fractures due to osteoporosis (brittle bones) are the leading causes of death in women with T1D. Both diseases share certain common risk factors such as age, menopause, smoking, physical inactivity, and diabetes. Research studies have demonstrated a link between heart disease and osteoporosis in the general population. Population-based studies have shown that loss of bone mineral density (BMD) in elderly women is associated with higher heart disease mortality. Moreover, studies have shown a reduction in heart disease risk by treating osteoporosis with bisphosphonates. Since high blood sugar and low estrogen levels are associated with higher risk for both heart disease and osteoporosis, we hypothesize that postmenopausal women with T1D will have lower BMD at common fractured sites and more extensive signs of early heart disease than postmenopausal women without diabetes. We also hypothesize that bone and inflammatory markers measured in the blood will predict the occurrence of these two diseases.

Consistent with our hypotheses, we are planning to measure BMD and early signs of heart disease in 50 postmenopausal women T1D and 50 postmenopausal women without diabetes.  We will assess relevant medical, personal, family and diabetes history, treatment and complications, and history of falls and fractures in addition to measuring BMD at commonly fractured sites and comprehensive blood work including markers for inflammation and bone metabolism. We will correlate BMD and these markers with measures of heart disease.

The findings of this clinical study will improve our understanding of the association between bone and heart health in postmenopausal women with T1D and will help to design future studies to identify biomarkers to screen for both diseases to prevent illness and death associated with them.​