Glycemic control and bone mineral density in children and adolescents with type 1 diabetes

Fuusager, Gitte; Christesen, Henrik Thybo; Milandt, Nikolaj; Schou, Anders

doi:10.1111/pedi.12861

Cited by 23 publications

(27 citation statements)

References 35 publications

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“…This concurs with other studies showing the negative impact of poor glycemic control on bone. ( 8,12,27–29 ) Our initial logistic regression analysis suggested that the duration of DM may be related to changes in tibial microarchitectural properties; however, this relationship disappeared after adjusting for age and gender. This is in agreement with other studies.…”

Section: Discussionmentioning

confidence: 98%

Impact of Type 1 Diabetes Mellitus on Skeletal Integrity and Strength in Adolescents as Assessed by HRpQCT

et al. 2020

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Adults with type 1 diabetes mellitus (T1DM) are at risk of premature osteoporosis and fractures. The onset of T1DM typically starts during childhood and adolescence. Thus, the effects of DM on the skeleton may be established during this period. Studies in children with T1DM primarily use DXA with conflicting results. We present the first study in adolescents assessing the impact of T1DM on skeletal microstructure and strength using HRpQCT. We recruited 22 patients aged 12 to 16 years with T1DM who were matched by age, gender, and pubertal stage with healthy controls. Paired t tests were applied to assess differences in cortical and trabecular microarchitecture measurements from HRpQCT, and skeletal strength from HRpQCT-derived microfinite element analysis. Subtotal body, lumbar, and pelvic parameters were assessed using DXA. There was no significant difference in subtotal body, lumbar spine, and pelvic BMD between T1DM and control pairs. However, tibial trabecular thickness was lower (−0.005 mm; 95% CI, −0.01 to −0.001; p = 0.029) and trabecular loading was lower at the distal radius (ratio of the load taken by the trabecular bone in relation to the total load at the distal end (Tb.F/TF) distal: −6.2; 95% CI, −12.4 to −0.03; p = 0.049), and distal and proximal tibia (Tb.F/TF distal: −5.2, 95% CI, −9.2 to −1.2; p = 0.013; and Tb.F/TF proximal: −5.0, 95% CI, −9.8 to −0.1; p = 0.047) in T1DM patients. A subanalysis of radial data of participants with duration of T1DM of at least 2 years and their matched controls demonstrated a reduced trabecular bone number (−0.15, 95% CI, −0.26 to −0.04; p = 0.012), increased trabecular separation (0.041 mm, 95% CI, 0.009-0.072; p = 0.015), an increased trabecular inhomogeneity (0.018, 95% CI, 0.003-0.034; p = 0.021). Regression models demonstrated a reduction in tibial stiffness (−0.877 kN/mm; p = 0.03) and tibial failure load (−0.044 kN; p = 0.03) with higher HbA1C. Thus, in adolescents with T1DM, detrimental changes are seen in tibial and radial microarchitecture and tibial and radial strength before changes in DXA occur and may result from poor diabetic control.

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Section: Discussionmentioning

confidence: 98%

Impact of Type 1 Diabetes Mellitus on Skeletal Integrity and Strength in Adolescents as Assessed by HRpQCT

et al. 2020

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“…In some studies, children with type 1 diabetes have reduced aBMD, [7][8][9] but not in all. [10][11][12] We among others also found an association between poor glycemic control and lower total body aBMD in children with type 1 diabetes. 12 13 Bone dimensions influence the results in DXA, as it is a two-dimensional scanning method assessing a threedimensional structure.…”

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confidence: 80%

Lower estimated bone strength and impaired bone microarchitecture in children with type 1 diabetes

Fuusager

Milandt

Shanbhogue

et al. 2020

BMJ Open Diab Res Care

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IntroductionPatients with type 1 diabetes has an increased risk of fracture. We wished to evaluate estimated bone strength in children and adolescents with type 1 diabetes and assess peripheral bone geometry, volumetric bone mineral density (vBMD) and microarchitecture.Research design and methodsIn a cross-sectional study, high-resolution peripheral quantitative CT (HR-pQCT) was performed of the radius and tibia in 84 children with type 1 diabetes and 55 healthy sibling controls. Estimated bone strength was assessed using a microfinite element analysis solver. Multivariate regression analyses were performed adjusting for age, sex, height and body mass index.ResultsThe median age was 13.0 years in the diabetes group vs 11.5 years in healthy sibling controls. The median (range) diabetes duration was 4.2 (0.4−15.9) years; median (range) latest year Hb1Ac was 7.8 (5.9−11.8) % (61.8 (41−106) mmol/mol). In adjusted analyses, patients with type 1 diabetes had reduced estimated bone strength in both radius, β −390.6 (−621.2 to −159.9) N, p=0.001, and tibia, β −891.9 (−1321 to −462.9) N, p<0.001. In the radius and tibia, children with type 1 diabetes had reduced cortical area, trabecular vBMD, trabecular number and trabecular bone volume fraction and increased trabecular inhomogeneity, adjusted p<0.05 for all. Latest year HbA1c was negatively correlated with bone microarchitecture (radius and tibia), trabecular vBMD and estimated bone strength (tibia).ConclusionChildren with type 1 diabetes had reduced estimated bone strength. This reduced bone strength could partly be explained by reduced trabecular bone mineral density, adverse microarchitecture and reduced cortical area. We also found increasing latest year HbA1c to be associated with several adverse changes in bone parameters. HR-pQCT holds potential to identify early adverse bone changes and to explain the increased fracture risk in young patients with type 1 diabetes.

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“…Recently, two Danish studies have demonstrated that bone mineral density (BMD) in children and adolescents with type 1 diabetes (T1D) was not decreased as demonstrated in several studies including adults with T1D . Already from early childhood an increased risk of bone fractures have been reported in individuals with T1D compared with healthy controls .…”

Section: Introductionmentioning

confidence: 99%

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

et al. 2020

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Background and aim: Adults with type 1 diabetes (T1D) have increased risk of bone fractures and decreased bone mineral density (BMD). Alterations in bone turnover have been suggested as the link between T1D and the impaired bone health. Furthermore, bone turnover has been suggested to have beneficial effects on glucose metabolism. This study aimed at describing bone turnover markers (BTM), and the relationship with glycemic control, in children and adolescents with T1D.Methods: A total of 173 (47% girls) children and adolescents aged 7.7 to 17.5 years with T1D for more than 1 year were included. Participants were evaluated by BMD together with measurements of selected BTM; two formation markers: osteocalcin (OCN) and procollagen type-1 amino-terminal propeptide (P1NP) and one resorption marker, C-terminal cross-linked telopeptide of type-1 collagen (CTX). BTM were converted into Z-scores utilizing new national references.Results: Mean OCN Z-score (−0.68 ± 1.31), P1NP Z-score (−0.33 ± 1.03) and CTX Z-score (−0.43 ± 1.10) were all significantly lower than the reference population (P < .001). No associations were seen between BTM and T1D duration. BMD Z-score was comparable to the reference population and associated with none of individual BTMs. CTX Z-score was negatively associated with HbA1c (P = .007) independent of both exogenous and residual endogenous insulin.Conclusions: Markers of bone formation and resorption were decreased in children and adolescents with T1D. CTX Z-score associated negatively with HbA1c adjusted for insulin treatment and endogenous insulin production indicating a potential

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Glycemic control and bone mineral density in children and adolescents with type 1 diabetes

Cited by 23 publications

References 35 publications

Impact of Type 1 Diabetes Mellitus on Skeletal Integrity and Strength in Adolescents as Assessed by HRpQCT

Impact of Type 1 Diabetes Mellitus on Skeletal Integrity and Strength in Adolescents as Assessed by HRpQCT

Lower estimated bone strength and impaired bone microarchitecture in children with type 1 diabetes

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

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