الفهرس 
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Abstract
DM is a rising health problem with substantial morbidity and mortality.
Diabetic patients with comorbidities had a much lower health status compared to those without any comorbidity, especially diabetes patients with co-existing macrovascular comorbidity like ischemic heart disease with or without cardiac failure, peripheral arterial disease and cerebrovascular stroke.
Osteoporosis characterized by deteriorated bone strength and represent a national burden in the aging society, which could result in impaired quality of life for the affected patients.
Osteoporotic fragility fractures impose a considerable financial burden on health services due to reduced mobility, hospitalization, and nursing home facilities.
IGF-1 is the primary mediator of the effects of growth hormone and shares structural homology with insulin. Increasing evidence suggests a role of the IGF axis in the maintenance of normal glucose homeostasis and inflammation.
The current study was conducted to study the relationship between IGF -1 and BMD in elderly diabetic patients. The study included 90 elderly diabetic males and females who divided into 3 groups, group (A) consisted of 30 patients had DM with macrovascular comorbidity, group (B) contained 30 patients with DM but without macrovascular comorbidity, while group (C) was the control group with also 30 elderly subjects without DM. Each patient underwent: comprehensive geriatric assessment, laboratory investigations: FBS, 2hPP, serum IGF-1.
Also, DEXA was done for every patient on lumber spine and hip region.
Any patient with Diseases, medications affecting BMD, IGF-1 or refused to participate in the study was excluded from recruitment.
Our study results revealed that, there was significant negative correlation between age and bone mineral density.
Also, there was significant statistical difference between female gender among groups and low BMD, as female participants include the highest percentage of osteoporotic individuals, while male gender showed no significant statistical difference in the same previous relationship. The highest percentage of osteoporotic subjects located in the non-diabetic control group in comparison to other diabetic groups.
Moreover, There was significant statistical association between PVD and low BMD, while heart failure, IHD and old CVS showed no significant statistical association as regard analysis of co-morbid conditions among group (A)”Diabetics with comorbidity”.
In addition, in the current work, there was no significant statistical association regarding serum level of IGF-1 and BMD.
In addition, there was significant statistical difference between groups as regard the functional status using ADL scale and IADL scale, being the high rate of dependency was among elderly diabetic patients with comorbidities.
Lastly, there was significant statistical difference among groups regarding fall history assessment, being the majority of cases with fall history were among diabetics with comorbidities.