Thoracic spine fracture in the course of severe nocturnal hypoglycemia in young patients with type 1 diabetes mellitus-the role of low bone mineral density

Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed. We report three type 1 diabetes cases in young patients with durations of 2, 4, and 19 years. These patients had severe hypoglycemic attacks during night sleep with subsequent compression thoracic vertebrae fractures. Laboratory parameters for diabetes control, calcium, phosphate metabolism and celiac-specific antibodies were assessed. Moreover, kidney, thyroid, and parathyroid gland functions were also measured. Bone mineral density was assessed by dual energy x-ray absorptiometry. Lumbar spine x-ray absorptiometry revealed very low bone mineral density in all three patients. In all subjects, metabolic control was good, no chronic diabetes complications were found and other laboratory parameters were within a normal range. For the first time, it was demonstrated that low bone mineral density in young type 1 diabetes patients may contribute to an increased compression fracture risk of the dorsal spine during severe nocturnal hypoglycemia courses. The possibility of osteoporosis in young patients with short diabetes durations suggests it might be advisable to perform bone mineral density testing during diabetes diagnoses. Spinal pain occurrences in young patients after severe nocturnal hypoglycemia should be investigated using procedures for the diagnosis of vertebral compression fracture, even if there is no evident trauma.