Childhood type 1 diabetes is associated with abnormal bone development

Abstract

Objective: To describe bone mineral density (BMD), bone structure, and fracture prevalence in adolescents with type 1 diabetes (T1D) and explore their associations with glycemic control and microvascular complications.Research design and methods: Cross sectional study of 64 adolescents (38 males) with T1D duration >10 years who underwent dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), fracture survey, plantar fascia thickness, and microvascular complications assessment.Results: Mean age was 16.6 ± 2.1 years, diabetes duration 12.8 ± 2.2 years and HbA1c 8.9 ± 1.7% (74 mmol/mol). Fracture prevalence was 50%. DXA areal BMD (Z-score) was reduced for femoral neck (À0.5 ± 1.3, p = 0.008) and arm (À0.4 ± 1.0, p < 0.001), while total areal BMD and lumbar spine BMD were normal. In pQCT (Z-score), trabecular volumetric BMD (vBMD) was reduced for tibia (À0.4 ± 0.8, p < 0.001) and radius (À0.8 ± 1.4, p < 0.001) whereas cortical vBMD was increased at both sites (tibia: 0.5 ± 0.6, p < 0.001, radius: 0.7 ± 1.5, p < 0.001). Muscle crosssectional area (CSA) was reduced for upper (À0.6 ± 1.2, p < 0.001) and lower (À0.4 ± 0.7, p < 0.001) limbs. DXA total areal BMD was positively correlated with BMI (p < 0.01) and age at T1D diagnosis (p = 0.04). Lower radial bone CSA, total and lumbar spine BMD were associated with autonomic nerve dysfunction. HbA1c, diabetes duration, fracture history and other microvascular complications were not significantly associated with bone parameters.Conclusions: Adolescents with childhood-onset T1D have site-specific bone deficits in upper and lower limbs but normal total and lumbar spine BMD. T1D appears to have differential effects on trabecular and cortical bone compartments. Future longitudinal analysis is warranted to examine whether these changes translate in to increased fracture risk.The study results were presented in an oral session at 45th Annual meeting of the

Does metabolic control of the disease related with bone turnover markers in children with type 1 diabetes mellitus in Turkey?

“…In another study, Madsen et al [25] examined OC, P1NP, and CTX levels in 99 individuals with T1DM 3 months after diagnosis and three times at 6-month intervals and showed that bone destruction increased and bone turnover decreased in the first year after T1DM diagnosis. Vora et al [26] evaluated dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), plantar fascia thickness, and microvascular complications in 64 adolescents with a duration of T1DM > 10 years and found site-specific low bone density in the upper and lower extremities. Eckert et al [27] compared T1DM patients aged ≤ 25 years with a history of bone fracture with T1DM patients without a history of bone fracture and reported that bone fractures were more common at an earlier age in T1DM patients than in the general population and that the risk of fracture was associated with HbA1c levels.…”