Study of bone loss in diabetes mellitus type 1

Leon, M Wilford De; Larrodera, L; Lledó, Gregorio; Hawkins, Federico

doi:10.1016/0168-8227(89)90035-1

Cited by 39 publications

(26 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In order to analyze whether the severity of diabetes at the clinical onset could have exerted any effect on the BMD, lumbar BMD z scores were compared between patients presenting with or without DKA at the onset of diabetes, and no differences were found. At variance with previous studies [2, 4, 5, 6, 9, 10, 25], but in agreement with others [3, 8, 12], we found a negative relationship between lumbar BMD z scores and duration of diabetes, indicating, therefore, that the abnormality in BMD may worsen with ongoing disease.…”

Section: Discussioncontrasting

confidence: 56%

“…As can be seen from table 2, the lumbar spine is the most frequently investigated site, since it contains mainly trabecular bone which is metabolically highly active: this site may be very sensitive to derangements occurring in the mineralization process, particularly in young people [23]. At variance with three studies [10, 24, 25], most studies agree on the fact that BMD values in diabetic patients, although in the normal range, were significantly lower than in controls [2, 3, 4, 5, 6, 7, 8, 9]. Our results, too, indicate that the mean BMD z scores at the lumbar site were significantly lower than the mean of the reference value, as the 95% value of the CI of the mean was entirely below 0.…”

Section: Discussionmentioning

confidence: 75%

“…However, the effect of poor metabolic control on the BMD has been excluded by several authors [3, 4, 5, 6, 9, 10, 25], but sustained by Lettgen et al [8]in children and by Olmos et al [12]in adults. The reason of these conflicting results may be explained by the fact that most authors considered the Hb A 1c values present at the time of the study which obviously represent the metabolic control of the last 2–3 months.…”

Section: Discussionmentioning

confidence: 99%

“…Type 1 diabetes mellitus is the most frequent endocrine system disease in childhood which may have negative effects on bone turnover and mineralization. A reduced bone mineral density (BMD) has been variously documented in children and adolescents with type 1 diabetes [2, 3, 4, 5, 6, 7, 8, 9, 10], but there are still conflicting data on whether it may be influenced by duration of the disease or poor metabolic control. Pathogenetic mechanisms leading to diabetic osteopenia have been alternatively ascribed either to a low turnover status, with decreased bone resorption and formation [11, 12, 13], or to a high turnover status, with increased bone resorption, hypercalciuria, and hyperphosphaturia [14, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

Valerio

Puente²,

Puente³

et al. 2002

Horm Res Paediatr

113

View full text Add to dashboard Cite

Aim: To analyze whether bone mineral density (BMD) and bone resorption status are influenced by long-term metabolic control and duration of disease in adolescents with long-standing type 1 diabetes mellitus. Methods: Twenty-seven adolescents (age 13.1 ± 1.7 years, duration of diabetes 6.9 ± 3.0 years) were studied. The BMD, expressed as z score, was measured at the lumbar spine (L1–L4) using dual-energy X-ray absorptiometry, while the urinary excretion of total deoxypiridinoline (Dpyd), a marker of bone resorption, was measured by immunoassay and was corrected by creatinine (Cr). Linear and multivariate correlations between lumbar BMD z score or Dpyd/Cr excretion and age and disease variables [short-term (Hb A_1clatest) or long-term (Hb A_{1cwholeduration}) metabolic control, duration, ‘diabetes impact index’ (mean Hb A_{1cwholeduration} x duration of disease in months)] were sought. Results: In diabetic subjects the mean BMD z score was –0.44 ± (SD) 1.02 (95% CI: –0.03; –0.84), and the Dpyd/Cr excretion was not increased. A negative correlation was found between lumbar BMD z score and age (r –0.59; p = 0.001), duration (r –0.39; p = 0.04), and the diabetes impact index (r –0.4; p = 0.04). The Dpyd/Cr ratio correlated negatively with age (r –0.40; p = 0.04) and positively with height velocity (r 0.42; p = 0.04). By using multiple linear regression, age showed a significant inverse correlation with lumbar BMD z score (β = –0.39; p = 0.0005). A negative correlation was found between lumbar BMD z score and Hb A_{1cwholeduration} (β = –0.40; p = 0.02) or diabetes impact index (β = –0.001; p = 0.01). Conclusions: Poor metabolic control may expose adolescents with long-standing type 1 diabetes to the risk of developing osteopenia in adult age. Optimization of metabolic control in growing diabetic children may prevent osteoporosis in later life.

show abstract

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

Valerio

Puente²,

Puente³

et al. 2002

Horm Res Paediatr

113

View full text Add to dashboard Cite

show abstract

“…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%

Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Schepper

Smitz²,

Rosseneu

et al. 1998

Horm Res Paediatr

View full text Add to dashboard Cite

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.

show abstract

Connective Tissue Disorders in Diabetes

Rosenbloom¹

2004

International Textbook of Diabetes Mellitus

View full text Add to dashboard Cite

Connective tissue disorders in diabetes encompass the major long‐term complications, which can be attributed to alternation in the quantity and quality of structural macromolecules of the extracellular matrix. This chapter reviews the abnormalities of interstitial connective tissue involving skeleton, joints, skin, and periarticular tissues that have been considered to be associated with diabetes, including osteopenia in children and adults; hyperostosis; osteoarthritis; rheumatoid arthritis; osteolysis; scleroderma diabeticorum; Dupuytren disease; stiff hand syndrome of Lundbaek; carpal tunnel syndrome; flexor tenosynovitis; adhesive capsulitis of the shoulder and shoulder–hand syndrome; and limited joint mobility (LJM). Despite an extensive literature defining the characteristic features of the six distinct conditions resulting in limitation of hand joint mobility, recognition of the fact that these are different entities, although they may coexist, is often not appreciated. Among these conditions affecting hand joint mobility, LJM is unique in that it can occur in children and adolescents, in whom it was originally described, does not occur in the nondiabetic young population, is an important risk marker for other complications, correlates with long‐term metabolic control, and has markedly decreased in frequency over the past 20 years, presumably as a result of improved control of type 1 diabetes in children.

show abstract

Study of bone loss in diabetes mellitus type 1

Cited by 39 publications

References 10 publications

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Connective Tissue Disorders in Diabetes

Contact Info

Product

Resources

About