The Role of Hormones in the Premature Vascular and Bone Disease in Women with Type 1 Diabetes
Women with type 1 diabetes (T1D) face at least a 4-fold increased risk for cardiovascular disease (CVD) compared to women without diabetes, and have a similarly increased risk for osteoporosis and fractures. It is recognized that CVD and bone disease associated with ageing likely share common risk factors and pathways, and it is thought that estrogen plays a key role in the increasing risk for both CVD and osteoporotic fracture as women transition through menopause. Yet, few studies have examined how reproductive hormones and the transition through menopause affect both vascular and bone health in women with type 1 diabetes. Therefore, we propose to examine how levels of sex hormones and use of exogenous hormones prior to menopause as well as during menopause may differ in women with T1D compared to women without diabetes, and how both hormone levels and exposure to exogenous hormones (birth control and post-menopausal hormone therapy) are related to cardiovascular risk over 15 years of follow-up, markers of bone formation and resorption, and fracture risk. For this pilot study, we propose to examine these questions using blood samples and data collected as part of the longitudinal Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study, which has followed 352 women with T1D and 381 non-diabetic women for the development of complications for over 15 years. In addition, we plan to examine trabecular bone score (TBS), a novel marker of bone microarchitecture, in a pilot study of 100 postmenopausal women from the CACTI study cohort (50 with T1D and 50 non-diabetic) who are currently enrolled in a pilot study to examine bone mineral density.

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