Osteopenia in patients with type 1 diabetes: prevalence and some aspects of pathophysiology

To evaluate the prevalence of osteopenia in patients with type 1 diabetes and its relationship to the metabolic control of diabetes. Also, to study if there is any changes in the biochemical markers of bone formation in type 1 diabetics. This study included 50 male patients with uncomplicated type 1 diabetes, their ages ranged from 18 to 33 years with mean +/- SD [25.3 +/- 5.4 years] and also, sex and aged matched 20 healthy subjects were included as control group. The bone mineral density was measured at the calcaneal bone for all participants using quantitative ultrasonometry. Laboratory evaluation also was done, including glycosylated hemoglobin, serum levels of calcium, phosphate, alkaline phosphatase and osteocalcin. The prevalence of osteopenia in patients with type 1 diabetes was 62% and 8% of type 1 diabetics met the criteria of osteoporosis. Type 1 diabetic patients had significantly lower levels of mean serum osteocalcin than the control group. Also, type 1 diabetic patients with calcaneal osteopenia had significantly higher levels of mean serum glycosylated hemoglobin and sign significantly lower levels of mean serum osteocalcin than those diabetics without calcaneal osteopenia. Osteopenia is frequent in patients with type 1 diabetes with prevalence of 62% and 8% of type 1 diabetics met criteria of osteoporosis. This diabetic osteopenia results mainly from decreased bone formation and the poor metabolic control. We recommend screening of type 1 diabetics for osteopenia and optimization of metabolic control to prevent osteoporosis

Early detection of macro vascular diseases of carotid and femoral arteries in patients with Rheumatoid arthritis

Rheumatoid arthritis [RA] is a multi-system disorder with inflammatory process associated with increased cardiovascular risk. The duplex scanning is a noninvasive technique to detect early atherosclerotic plaques and arterial wall changes either in symptomatic or asymptomatic patients. Early detection of asymptomatic vascular disorders allows early intervention and possibly retards the development of symptomatic cardiovascular diseases. A higher risk of cardiovascular morbidity and mortality persists among patients with an abnormal ankle brachial index [ABI] and it is useful to identify asymptomatic patients with established disease. To detect the early manifestations of atherosclerotic changes of carotid and femoral arteries in patients with rheumatoid arthritis. Twenty-four patients with chronic rheumatoid arthritis [six males and eighteen females] aged 26-65 years [45.7 +/- 14.7 years] with mean disease duration 11.12 +/- 6.4 years [2-18 year] were included in the study. All patients were on methotrexate, corticosteroids and nonsteroidal anti-inflammatory lines of treatment. Twenty apparently normal subjects were included in the study as controls. Patients with other types of collagen diseases or patients with ischemic peripheral manifestations, ischemic heart disease, diabetics or smokers were excluded from the study. Full history and thorough clinical examination, including full joints and vascular examination for all peripheral arteries and calculation of ankle brachial index [ABI] was done using pocket Doppler and sphygmomanometer. Patients and controls were subjected for Hb, WBC, platelet count, rheumatoid factor, blood sugar, ESR, levels of plasma cholesterol, triglyciride, HDL and LDL. Duplex study was performed on carotid and femoral arteries. The mean ABI in patients was 1.21 +/- 0.3, non-significantly lower than controls but still within the range of normal. There was a significant increase in the levels of cholesterol, triglyciride, LDL and HDL than controls and still within the range of normal. Duplex changes of carotid and femoral arteries were present in 18/24 [75%] of patients including hemodynamic changes, intimal thickness, plaques, stenotic segment. Duplex of carotid arteries detected hemodynamic changes in 12.5%, intimal thickness, plaques and stenotic segment in 25% of patients for each and detected intimal thickness of femoral arteries in 25% of patients. There was a significant negative correlation between the ABI and duration of disease [r = - 0.506, p<0.01] and a significant positive correlation between the intimal thickness and duration of disease [r =-0.807, p<0.001]. There was no relation between drug intake or type of drug and ABI or intima thikness and there was no relation between cholesterol, triglyciride, LDL or HDL levels and ABI or intimal thickness. There is increased risk of vascular disease in RA patients involving carotid and femoral arteries in the form of hemodynamic changes, intimal thickness, plaques and stenotic segment. Low ABI together with Duplex study are helpful for detection of subclinical ischemic changes in such high-risk patients. Normal levels of plasma cholesterol, triglyciride, HDL and LDL do not exclude underlying vascular changes. So we recommend ABI and Duplex examination for all RA patients and further studies are needed to elucidate non-traditional risk factors such as endothelial dysfunction, immune activation and impaired fibrinolysis in addition to oxidative stress