Diminution of Bone Mass in Childhood Diabetes

Rosenbloom, Arlan L.; Lezotte, Dennis C.; Weber, F.Parkes; Gudat, John C.; Heller, Debbie; Weber, MM; Klein, Steven L.; Kennedy, Brittany

doi:10.2337/diab.26.11.1052

Cited by 86 publications

(16 citation statements)

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“…Previous BMD investigations in diabetic children at the forearm by peripheral quantitative computer tomography or single-photon absorptiometry showed a relative BMD decrease with estimates ranging from 5% to as much as 21% [1, 2, 3, 4, 5, 16]. It is not clear from our study why peripheral bone would be more significantly affected than the axial skeleton in diabetes disease.…”

Section: Discussioncontrasting

confidence: 53%

“…The use of different techniques, measurements at different skeletal sites, inclusion of patients with different ages, duration of disease, degree of growth retardation and metabolic control might be responsible for these discordant findings. In the majority of these studies in diabetic children BMD was assessed at the level of the peripheral skeleton [1, 2, 3, 4, 5], whereas the experience with determinations at the level of the lumbar spine is limited [6, 7]. The lumbar spine contains mainly trabecular bone, which by its higher turnover rate compared to compact bone is more sensible to metabolic and endocrine changes, as observed in puberty, vitamin D deficiency and hypoparathyroidism [8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Schepper

Smitz²,

Rosseneu

et al. 1998

Horm Res Paediatr

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To detect early abnormalities in bone mineralization, the lumbar spine bone mineral density (BMD) of diabetic children with a diabetes onset of less than 5 years and treated with a similar insulin treatment scheme was measured at the level of the lumbar spine by dual-energy X-ray absorptiometry (DEXA), a most sensitive technique for detecting osteopenia in children. Fifteen male and 8 female children and adolescents (mean age ± SD: 12.5±3.7 years), 1–5 years after the clinical onset of their diabetes, were studied. Measurements of the lumbar spine (L₁–L₄) BMD, expressed in gHA/cm² and as a z-score for age, were performed with a commercial DEXA apparatus (Hologic QDR 1000 W, Hologic Inc., Waltham, USA). Calcium-phosphorus metabolism was studied by measuring the circulating levels of calcium, phosphorus, alkaline phosphatase, osteocalcin, 25-OH-vitamin D and parathyroid hormone and the urinary excretion of calcium and phosphorus. The mean BMD of the studied group was 0.75 (0.16) gHA/cm² giving a mean z-score of –0.31±0.95. Only 1 of the patients had a BMD lower than –2 SD. No sex difference in BMD z-score existed. BMD SD was positively correlated with height SD (R = 0.56, p < 0.005), but not with the age of the patients, the duration of the disease, the degree of metabolic control or the studied parameters of the calcium-phosphorus metabolism. In conclusion, diabetic children have a normal lumbar spine BMD during the first years of the disease, when a good metabolic control and no abnormalities in the calcium-phosphorus metabolism are present. As in normal children, areal BMD by DEXA is highly dependent on the body height, necessitating corrections if abnormalities in skeletal growth or pubertal development exist.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Schepper

Smitz²,

Rosseneu

et al. 1998

Horm Res Paediatr

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“…The beneficial roles of insulin on skeletal health has been entertained by many authors [1], supported by the observations that lower BMD in type 1 diabetes [2,3] and higher BMD in subjects with type 2 diabetes [4,5]. We found that there are stronger associations of BMAD with fasting insulin and insulin AUC in AA adolescents.…”

Section: Discussionsupporting

confidence: 85%

Higher Serum Insulin Concentrations Positively Influence the Bone Mineral Density in African American Adolescents

Ashraf

Alvarez

Huisingh

et al. 2013

BJMMR

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BackgroundPuberty is a developmental stage of increased insulin resistance that also is a critical period for bone mass accrual. Historically, African Americans (AA) have lesser risk for osteoporotic fractures compared to European Americans (EA). AA also have higher incidence of insulin resistance. The possibility that bone health and insulin secretion or concentrations are linked has not been investigated.AimsWe aimed to examine the associations of bone mineral density (BMD) and bone mineral apparent density (BMAD) with insulin sensitivity and secretion in healthy adolescent girls and healthy female adults and to evaluate ethnic differences in these associations.Study DesignObservational cohort design.Place and Duration of the StudyUniversity of Alabama at Birmingham, between January 2010 and September 2011.MethodologyHealthy, female, non-smoking adolescents and young adults (14–55 years) were enrolled in this observational cohort study.ResultsAdolescents had significantly higher fasting insulin (P=0.0002), insulin area under the curve [AUC] (P= 0.0004) and lower insulin sensitivity (P=0.0005) compared to adults. Among adolescents, AA race was significantly associated with BMD (β=0.086, P=0.01) and BMAD (β=0.0075, P=0.002); however, adjusting for insulin AUC explained this difference. Insulin AUC (β=0.0006, P=0.029) and fasting insulin (β=0.0005, P=0.01) were positively associated with BMAD only in AA adolescents. Insulin AUC and fasting insulin were not significant predictors of BMD for adults.ConclusionThe higher insulin concentration among AA adolescents is associated with increased BMD and higher BMAD.

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“…[9] Many studies, though not all, carried out with the older techniques to measure BMD, like single photon absorptiometry (SPA) or dual photon absorptiometry (DPA), demonstrated that BMD is lower in adolescents and adults with T1DM compared to control population. [1011121314] Similar findings have been noted by the recent studies carried out using newer technologies to measure BMD like dual X-ray absorptiometry (DXA). [15161718] However, the data is not consistent among all the studies.…”

Section: Epidemiology Of Osteoporosis In Patients With T1dmsupporting

confidence: 67%

Type 1 diabetes and osteoporosis: A review of literature

Dhaon¹,

Shah²

2014

Indian J Endocr Metab

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With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM). Therefore, there is a need to change the focus from microvascular complications to cardiovascular disease and osteoporosis. Though number of studies from other parts of the world show that patients with T1DM are at increased risk of osteoporosis and fractures, there is a paucity of data from India. A number of factors and mechanisms affecting bone health in patients with T1DM have been proposed. The main defect in genesis of osteoporosis is osteoblastic function, rather than osteoclastic overfunction. Assessment of bone mineral density by dual X-ray absorptiometry and other risk factors for osteoporosis, as a part of diagnostic procedure can help to design tailored treatment plans. A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis. Treatment of osteoporosis is not evidence based but it is proposed to be similar to osteoporosis associated with other conditions. Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM. However, more studies are needed to make definitive guidelines on prevention and treatment of osteoporosis in patients with T1DM.

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Diminution of Bone Mass in Childhood Diabetes

Cited by 86 publications

References 0 publications

Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Higher Serum Insulin Concentrations Positively Influence the Bone Mineral Density in African American Adolescents

Type 1 diabetes and osteoporosis: A review of literature

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