Skeletal fragility and its clinical determinants in children with type 1 diabetes

Chen, S. C., Shepherd, S., McMillan, M., Mcneilly, J., Foster, J., Wong, S. C. , Robertson, K. J. and Ahmed, S. F. (2019) Skeletal fragility and its clinical determinants in children with type 1 diabetes. Journal of Clinical Endocrinology and Metabolism, 104(8), pp. 3585-3594. (doi: 10.1210/jc.2019-00084) (PMID:30848792)

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Abstract

Type 1 diabetes (T1D) is associated with an increased fracture risk at all ages. To understand the determinants of bone health and fractures in children with T1D. Case-control study of children with T1D on bone turnover markers, DXA and 3T-MRI of the proximal tibia to assess bone microarchitecture and vertebral marrow adiposity, compared to age and sex-matched healthy children. 32 children with T1D at a median (range) age of 13.7 years (10.4,16.7) and 26 controls aged 13.8 years (10.2,17.8) were recruited. In children with T1D, serum BAP SDS, CTX SDS, and total body and lumbar spine BMD SDS were lower (all p<0.05). Children with T1D also had lower trabecular volume [0.55 (0.47,0.63) vs 0.59 (0.47,0.63); p=0.024], lower trabecular number [1.67 (1.56,1.93) vs 1.82 (1.56,1.99); p=0.004] and higher trabecular separation [0.27 (0.21,0.32) vs 0.24 (0.20,0.33); p=0.001] than controls. Marrow adiposity was similar in both groups (p=0.25). Bone formation as assessed by BAP was lower in children with poorer glycemic control (p=0.009) and who were acidotic at initial presentation (p=0.017) but higher in children on continuous subcutaneous insulin infusion (p=0.025). Fractures were more likely to be encountered in children with T1D compared to controls [31% vs 19%; p<0.001]. Compared to those without fractures, the T1D children with a fracture history had poorer glycemic control (p=0.007) and lower total body BMD (p<0.001) but no differences in bone microarchitecture. Children with T1D display a low bone turnover state with reduced bone mineralisation and poorer bone microarchitecture. [Abstract copyright: Copyright © 2019 Endocrine Society.]

Item Type:Articles
Additional Information:Financial Support: Support for S.C.C. was provided by the Glasgow Children’s Hospital Charity.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wong, Dr Jarod and McMillan, Mr Martin and Robertson, Dr Kenneth and Shepherd, Dr Sheila and Mcneilly, Dr Jane and Chen, Suet and Foster, Dr John and Ahmed, Professor Syed Faisal
Authors: Chen, S. C., Shepherd, S., McMillan, M., Mcneilly, J., Foster, J., Wong, S. C., Robertson, K. J., and Ahmed, S. F.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Clinical Endocrinology and Metabolism
Publisher:Oxford University Press
ISSN:0021-972X
ISSN (Online):1945-7197

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