Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control.

Autor: Eckert AJ; Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.; German Centre for Diabetes Research (DZD), Neuherberg, Germany., Semler O; Faculty of Medicine and University Hospital Cologne, Department of Paediatrics, University of Cologne, Cologne, Germany., Schnabel D; Centre for Chronic Sick Children, Paediatric Endocrinology, Charité, University Medicine Berlin, Berlin, Germany., Köstner K; Social Pediatric Center (SPZ) Garmisch-Partenkirchen, German Centre for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany., Wurm D; Department of Paediatrics, Klinikum Saarbrücken, Saarbrücken, Germany., Bechtold-Dalla Pozza S; Paediatric Endocrinology, iSPZ, Dr. von Haunersches Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany., Schaaf K; Department of Paediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany., Hörtenhuber T; Department of Paediatrics, Kepler University Hospital, Linz, Austria., Hammersen J; Department of Paediatrics, University Hospital Erlangen, Erlangen, Germany., Holl RW; Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.; German Centre for Diabetes Research (DZD), Neuherberg, Germany.
Jazyk: angličtina
Zdroj: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research [J Bone Miner Res] 2021 Dec; Vol. 36 (12), pp. 2371-2380. Date of Electronic Publication: 2021 Oct 18.
DOI: 10.1002/jbmr.4451
Abstrakt: Type 1 diabetes (T1D) is a known risk factor for fractures, but the underlying pathophysiology is still not fully understood. This study aims to define age peaks and frequent fracture sites of children and young adults with T1D. Additionally, associations of fractures with metabolic and lifestyle factors as well as with additional complications in individuals with T1D were analyzed. A total of 750 individuals with T1D aged ≤25 years with fractures were matched to 3750 patients with T1D without fractures by demographics and insulin regimen. Hemoglobin A1c (HbA1c) values were compared using linear regression, and logistic regression was used to calculate odds ratios (OR) for fractures in individuals with acute complications and diseases. Median (Q1-Q3) age was 12.7 (9.9 to 14.9) years in individuals with fractures and 16.3 (12.6 to 17.8) years in the entire control group with 65% versus 53% males. Peak age for fractures was 7 to <15 years in males and 9 to <11 years in females, which is earlier than reported for the general population. HbA1c (%) was significantly higher in individuals with fractures than in controls (difference of estimated means: 0.26%; 95% confidence interval [CI] 0.07-0.46), especially in postpubertal females (0.68; 0.10-1.26). Significantly higher odds for fractures were observed in individuals with severe hypoglycemia (OR = 1.90; 95% CI 1.47-2.47), especially in prepubertal females (OR = 2.81; 1.21-6.52]) and postpubertal males (2.44; 1.11-5.38), celiac disease (2.02; 1.67-2.45), and with a history of smoking (1.38; 1.02-1.88). The age peak of fractures seems to be earlier in T1D than in the general population. Poor glycemic control is related to fractures, even before puberty. Associations of HbA1c and severe hypoglycemia with fractures highly depend on age and sex. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
(© 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).)
Databáze: MEDLINE
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