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

Fuusager, Gitte; Milandt, Nikolaj; Shanbhogue, Vikram Vinod; Hermann, Anne Pernille; Schou, Anders; Christesen, Henrik Thybo

doi:10.1136/bmjdrc-2020-001384

Cited by 15 publications

(12 citation statements)

References 38 publications

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“…All 3 studies showed a significant association between altered bone microarchitecture and poor glycaemic control. Consistent with most of the studies using pQCT, the trabecular compartment was primarily affected, although 1 study also found reduced cortical area [56]. In addition, Mitchell et al [57] showed decreased procollagen 1 N-terminal peptide (P1NP), a marker of bone formation, in T1DM, whereas there was no difference in C-terminal telopeptide (CTX), a marker of bone resorption.…”

Section: Outcomes Of Bone Geometry and Microarchitecture By Pqct Hrpq...supporting

confidence: 62%

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Impact of Type 1 Diabetes Mellitus on Bone Health in Children

Janner

Saner

2021

Horm Res Paediatr

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This paper gives an overview of the impact of type 1 diabetes on bone health in children and adolescents. First, we analyse studies using DXA (dual x-ray absorptiometry) to assess BMC (bone mineral content) and BMD (bone mineral density). Then, we discuss modern, non-invasive techniques including pQCT (peripheral quantitative computer tomography) and HRpQCT (high-resolution peripheral quantitative computer tomography) for the detailed assessment of bone health aspects including bone mass, bone geometry, bone microarchitecture and bone strength. Thereafter, we explore some of the mechanisms that are responsible for diabetic bone disease in children, like low bone turnover and high sclerostin levels. Finally, we summarise some of the evidence for the importance of microvascular disease in the pathophysiology of diabetic bone disease.

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Section: Outcomes Of Bone Geometry and Microarchitecture By Pqct Hrpq...supporting

confidence: 62%

“…Three studies in children with type 1 diabetes using HRpQCT (Table 2) showed an altered microarchitecture that is consistent with increased skeletal fragility [55][56][57]. In 2 of them, DXA measurements did not show any difference in BMC and BMD in T1DM compared to con- trols [55,57].…”

Section: Hrpqct In Children With T1dmmentioning

confidence: 88%

Impact of Type 1 Diabetes Mellitus on Bone Health in Children

Janner

Saner

2021

Horm Res Paediatr

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“…Studies of patients with T2DM included older patients with an average age of 63 years. Studies investigating bone characteristics of patients with T1DM included two studies in children aged 6 to 18 [ 26 , 27 ] and three studies in adults older than 18 with an average age of 47 years [ 28 , 29 ] …”

Section: Resultsmentioning

confidence: 99%

“…All adult studies reported using standard fixed offsets of 9.5 mm and 22.5 mm proximal from the radial and tibial reference lines, respectively. Paediatric studies, on the other hand, tended to adopt lower absolute (1.0 mm [ 26 ]) or relative (7% radial length and 8% tibial length [ 27 ]) proximal offsets. One study included data from the second-generation HR-pQCT system (XtremeCT II, Scanco Medical AG, isotropic voxel size of 61 μm), but parameters were converted to the first-generation scanner using calibration equations [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of Diabetes Mellitus-Associated Differences in Bone Structure Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Walle

Whittier

Frost

et al. 2022

Curr Osteoporos Rep

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Purpose of Review Diabetes mellitus is defined by elevated blood glucose levels caused by changes in glucose metabolism and, according to its pathogenesis, is classified into type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Diabetes mellitus is associated with multiple degenerative processes, including structural alterations of the bone and increased fracture risk. High-resolution peripheral computed tomography (HR-pQCT) is a clinically applicable, volumetric imaging technique that unveils bone microarchitecture in vivo. Numerous studies have used HR-pQCT to assess volumetric bone mineral density and microarchitecture in patients with diabetes, including characteristics of trabecular (e.g. number, thickness and separation) and cortical bone (e.g. thickness and porosity). However, study results are heterogeneous given different imaging regions and diverse patient cohorts. Recent Findings This meta-analysis assessed T1DM- and T2DM-associated characteristics of bone microarchitecture measured in human populations in vivo reported in PubMed- and Embase-listed publications from inception (2005) to November 2021. The final dataset contained twelve studies with 516 participants with T2DM and 3067 controls and four studies with 227 participants with T1DM and 405 controls. While T1DM was associated with adverse trabecular characteristics, T2DM was primarily associated with adverse cortical characteristics. These adverse effects were more severe at the radius than the load-bearing tibia, indicating increased mechanical loading may compensate for deleterious bone microarchitecture changes and supporting mechanoregulation of bone fragility in diabetes mellitus. Summary Our meta-analysis revealed distinct predilection sites of bone structure aberrations in T1DM and T2DM, which provide a foundation for the development of animal models of skeletal fragility in diabetes and may explain the uncertainty of predicting bone fragility in diabetic patients using current clinical algorithms.

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“…Hence, BMD cannot solely explain the increased fracture burden in T1D. Newer studies have suggested that people with T1D may also have an increased bone fragility from decreased bone quality, which partly explains the increased risk of fractures [19][20][21].…”

Section: Tablementioning

confidence: 99%

The pattern of incident fractures according to fracture site in people with T1D

et al. 2021

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Higher incidences of fractures are seen in people with type 1 diabetes (T1D), but knowledge on different fracture sites is sparse. We found a higher incidence mainly for distal fracture sites in people with T1D compared to controls. It must be further studied which fractures attributed to the higher incidence rates (IRs) at specific sites. Introduction People with T1D have a higher incidence of fractures compared to the general population. However, sparse knowledge exists on the incidence rates of individual fracture sites. Therefore, we examined the incidence of various fracture sites in people with newly treated T1D compared to matched controls. Methods All people from the UK Clinical Practice Research Datalink GOLD , of all ages with a T1D diagnosis code (n = 6381), were included. People with T1D were matched by year of birth, sex, and practice to controls (n = 6381). Fracture IRs and incidence rate ratios (IRRs) were calculated. Analyses were stratified by fracture site and sex. ResultsThe IR of all fractures was significantly higher in people with T1D compared to controls (IRR: 1.39 (CI95%: 1.24-1.55)). Compared to controls, the IRR for people with T1D was higher for several fracture sites including carpal (IRR:

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

Cited by 15 publications

References 38 publications

Impact of Type 1 Diabetes Mellitus on Bone Health in Children

Impact of Type 1 Diabetes Mellitus on Bone Health in Children

Meta-analysis of Diabetes Mellitus-Associated Differences in Bone Structure Assessed by High-Resolution Peripheral Quantitative Computed Tomography

The pattern of incident fractures according to fracture site in people with T1D

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