Skeletal Fragility and Its Clinical Determinants in Children With Type 1 Diabetes
| Autor: | John Foster, Sheila Shepherd, Suet Ching Chen, Martin McMillan, Jane McNeilly, Sze Choong Wong, S Faisal Ahmed, Kenneth J Robertson |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Bone density Adolescent Endocrinology Diabetes and Metabolism Clinical Biochemistry 030209 endocrinology & metabolism Biochemistry Bone remodeling 03 medical and health sciences Fractures Bone 0302 clinical medicine Endocrinology Absorptiometry Photon N-terminal telopeptide Bone Density Bone Marrow Diabetes mellitus Internal medicine Medicine Humans Child Glycemic Adiposity Bone mineral Type 1 diabetes Lumbar Vertebrae Tibia business.industry Biochemistry (medical) medicine.disease Magnetic Resonance Imaging 030104 developmental biology Diabetes Mellitus Type 1 Osteoporosis Female Bone Remodeling business Type I collagen |
| Zdroj: | The Journal of clinical endocrinology and metabolism. 104(8) |
| ISSN: | 1945-7197 |
| Popis: | Context Type 1 diabetes (T1D) is associated with an increased fracture risk at all ages. Objective To understand the determinants of bone health and fractures in children with T1D. Design Case-control study of children with T1D on bone-turnover markers, dual-energy X-ray absorptiometry, and 3 Tesla-MRI of the proximal tibia to assess bone microarchitecture and vertebral marrow adiposity compared with age- and sex-matched healthy children. Results Thirty-two 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 bone-specific alkaline phosphatase (BAP) SD score (SDS), C-terminal telopeptide of type I collagen SDS, and total body (TB) and lumbar spine bone mineral density (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 with controls (31% vs 19%; P< 0.001). Compared with those without fractures, the T1D children with a fracture history had poorer glycemic control (P = 0.007) and lower TB BMD (P < 0.001) but no differences in bone microarchitecture. Conclusion Children with T1D display a low bone-turnover state with reduced bone mineralization and poorer bone microarchitecture. |
| Databáze: | OpenAIRE |
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