Bone Mineral Density in Children and Adolescents with Diabetes Mellitus Type 1 of Recent Onset

Abstract

There is still controversy over the impact of diabetes control and duration on bone mass and growth parameters in children and adolescents with insulin-dependent diabetes mellitus (IDDM). The aim of this study was to assess bone mineral density (BMD) at axial and appendicular sites, in children with noncomplicated IDDM of recent onset, and its relation to metabolic control and auxological parameters (weight, height, and puberal stage). Fifty-five young Spanish IDDM, otherwise healthy patients (26 males, aged (SD 9.7 +/- 4.3 years) and 29 females, aged (SD 11.2 +/- 3.8 years) were studied. Duration of diabetes was 1-13.8 years. Two hundred eighty-two age-matched, healthy, Spanish children served as controls. HbA1 was assayed by high pressure liquid chromatography (HPLC) and BMD was measured using dual X-ray absorptiometry (DXA) densitometry at the spine and forearm. Results showed a Gaussian BMD distribution of patients according to sex and age, without sexual-stage differences. There was no correlation between BMD and glycated hemoglobin (average life disease or last HbA1 values) or duration of the disease; moreover, no differences in bone mass were found between <3 and >/=3 years of disease duration. Diabetes impact index (mean HbA1 x duration of disease in months) showed no significant influence of diabetes control on BMD. We could not demonstrate any impact of diabetes on BMD and growth parameters in children with IDDM of short duration.

Impaired Glucose Tolerance and Bone Mineral Content in Overweight Latino Children With a Family History of Type 2 Diabetes

“…Wakasugi et al (14) found no relationship between the level of HbA 1c and deficits in bone mass of type 2 diabetic adults. Pascual et al (15) found no correlation between BMD and HbA 1c in children with type 1 diabetes but acknowledged the fact that HbA 1c may not be an ideal marker for poor glycemic control because it represents only the patients' glycemic status of the last 3 months; it is noteworthy that changes in bone metabolism take place over a longer period. Although IGT (i.e., 2-h glucose Ն140 mg/dl) is an important precursor of diabetes (11), it is difficult to speculate the duration of this condition in our IGT children; nevertheless, we believe that inadequate duration of the pre-diabetic state may have contributed to the lack of significant differences in BMC and BMD of the two groups.…”

MECHANISMS IN ENDOCRINOLOGY: Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus

“…Most (27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44), although not all (45,46,47,48,49), studies report a significant decrease in BMD at either the spine, hip or total body. The magnitude of the decrease in BMD varied quite markedly from 8 to 67%, and large gender differences appear to be present, with many studies documenting changes in BMD in either males or females only.…”

Osteoporosis in Patients With Diabetes Mellitus

“…(19) Importantly, the majority of studies on patients with T1DM reported no association between BMD and glycemic control determined by hemoglobin A 1c serum levels. (5,7,8,11,12,14) …”