Skin Autofluorescence May Contribute to Prediction of Low Bone Quality in Type 1 Diabetes—A Clinical Cross-Sectional Study

Abstract

Introduction: People with type 1 diabetes are at risk of complications, including impaired bone health. Hyperglycaemia and accumulation of advanced glycation end products (AGEs) are involved in the development of those. Bone measurements such as trabecular bone score (TBS), high-resolution periphery quantitative computed tomography (HR-pQCT), and impact microindentation may detect impaired bone health better than bone mineral density (BMD). Clinical measures reflecting risk factors such as AGE accumulation or prevalence of cardiovascular autonomic neuropathy may also predict low bone quality. Methods: This cross-sectional study included 111 adults with type 1 diabetes and 37 healthy sex- and age-matched. Bone health was assessed through DXA with TBS, HR-pQCT and impact microindentation. Accumulation of AGEs was evaluated by skin autofluorescence, and screening for cardiovascular autonomic neuropathy was performed. Results: The mean (SD) age of the participants was 42.3 (13.8) years and the median (IQR) BMI was 26.9 [24.5; 30.1] kg/m2. Median SkinAGE value was higher in the type 1 diabetes group (2.1 [1.9; 2.7]) than in the control group (1.8 [1.6; 2.3]), p = 0.004. In the diabetes group, SkinAGE correlated with femoral neck, total hip BMD, and TBS. SkinAGE showed predictive value for low TBS upon adjustment for age, sex, and BMI. Conclusion: In persons with type 1 diabetes, higher levels of AGE accumulation measured by skin autofluorescence are related to a lower BMD as well as a lower TBS. Along with consideration of age, sex, BMI and other risk factors of osteoporosis, a high skin autofluorescence should increase the suspicion of impaired bone health.