Bone mineral acquisition in adolescents with type 1 diabetes

doi:10.1016/j.jpeds.2004.06.070

The Journal of Pediatrics

Volume 145, Issue 5, November 2004, Pages 662-669

https://doi.org/10.1016/j.jpeds.2004.06.070 Get rights and content

Objective

To track bone mineral acquisition in adolescents with type 1 diabetes (DM).

Study design

Subjects were adolescents, ages 12 to 18 years, with DM (n = 42) and a healthy regional reference (n = 199). Measurements of tibia bone characteristics by peripheral quantitative computed tomography (pQCT) and spine and whole body (WB) by dual-energy x-ray absorptiometry (DEXA), anthropometrics, and lifestyle questionnaires were obtained during a 12-month period. Disease duration, insulin dose, renal function, and glycosylated hemoglobin (HbA1c) values for the previous 12 months were recorded.

Results

Body size and maturation were similar between groups. DM had lower tibia, spine, and WB bone characteristics but greater muscle mass (LBM) and lower bone mineral content (BMC)/LBM at baseline and 12 months. Annual gains for tibia cortical bone and WB BMC/LBM were lower and inversely related to HbA1c levels (R = −0.36 to −0.51), whereas spine area and density and WBLBM were greater and were predicted by pubertal-driven growth. Overall, the DM cohort had 8.5% less WB BMC/LBM, suggesting that bone mineral deposition was not adequately adapted to muscle gains.

Conclusions

Adolescents with type 1 diabetes continue to have smaller bone mass and bone size despite normal growth and maturation. Poor metabolic control appears to negatively influence bone mineral acquisition.

Section snippets

Methods

Adolescents with type 1 diabetes from a previous cross-sectional study of bone health¹⁰ were recruited 1 year later from the Diabetes Treatment Center Pediatric Program, Salt Lake City, Utah. The University of Utah Institutional Review Board for Human Subjects approved this study, and new informed parental consent and participant assent was obtained. The same criteria used for baseline measurements of anthropometric and bone characteristics and questionnaires to determine pubertal maturation

Results

Forty-two adolescents with DM (26 male, 16 female) returned for 12-month follow-up bone measurements (82% retention rate). The ethnic distribution of 92.8% non-Hispanic white, 4.8% Hispanic, and 2.4% Asian was similar to the reference population and to the general population. There were no differences between subjects with DM and the reference group with respect to age, maturation, body size, calcium intake, and physical activity (Table I). Boys, as expected, were taller and heavier, although

Discussion

This study confirms that bone mineral acquisition, although driven by puberty, is influenced by disease-related factors in adolescents with type 1 diabetes. Trabecular vBMD remained lower than reference; however, we did not find an inverse relation with metabolic control, as had been previously reported by our research group and others.1., 7., 8. The majority of the cohort with DM had mean HbA_1c values between 5.9% and 10.9%, representing excellent to poor metabolic control. No subjects had HbA

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Original ArticleBone mineral acquisition in adolescents with type 1 diabetes

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

An Esp Pediatr

J Pediatr

Am J Clin Nutr

Metabolism

J Pediatr

Bone

Bone

Bone mineral density in children and adolescents with juvenile diabetes: selective measurement of bone mineral of trabecular and cortical bone using peripheral quantitative computed tomography

Horm Res

Intensive insulin therapy and bone mineral density in type 1 diabetes mellitus: a prospective study

Osteopor Int

Decreased lumbar spine bone mass and low bone turnover in children and adolescents with insulin dependent diabetes mellitus followed longitudinally

J Pediatr Endocrinol Metab

Decreased bone mineral density and bone formation markers shortly after diagnosis of clinical type 1 diabetes mellitus

J Pediatr Endocrinol Metab

Evaluation of bone mineral density in children with diabetes mellitus

Indian J Pediatr

The lumbar bone mineral density is affected by long-term poor metabolic control in adolescents with Type 1 diabetes mellitus

Horm Res

Diabetes mellitus: a risk for osteoporosis?

Exp Clin Endocrinol Diabetes

Parathyroid Gland and Metabolic Bone Disease: Selected Studies

Performance of a new pubertal self-assessment questionnaire: a preliminary study

Paediatr Perinat Epidemiol

Reproducibility and validity of an epidemiologic questionnaire to assess past year physical activity in adolescents

Am J Epidemiol

Original Article
Bone mineral acquisition in adolescents with type 1 diabetes