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Unaffected bone mineral density in Danish children and adolescents with type 1 diabetes

  • Jens Otto Broby Madsen
  • Camilla Winther Herskin
  • Bo Zerahn
  • Andreas Kryger Jensen
  • Niklas Rye Jørgensen
  • Birthe Susanne Olsen
  • Flemming Pociot
  • Jesper JohannesenEmail author
Original Article

Abstract

Aims

Adults with type 1 diabetes mellitus (T1D) have decreased bone mineral density (BMD). Our study aimed at determining BMD and the association to metabolic control in children and adolescents with T1D.

Methods

244 patients (113 girls) with a median age of 14.3 years and T1D duration of 1–16 years were included. A dual-energy X-ray absorptiometry scan assessed BMD Z-scores excluding the head (total body less head, TBLH). TBLH-BMD were then investigated for associations to diabetes relevant variables such as HbA1c, insulin treatment, anthropometry and physical activity.

Results

In all participants the TBLH-BMD Z-score (0.22 ± 0.96) was significantly higher than the references. Separated by sex, TBLH-BMD Z-score in boys (0.11 ± 0.84) was no different from healthy peers whereas TBLH-BMD Z-score was significantly higher in girls (0.36 ± 1.09). The higher TBLH-BMD Z-score in girls were explained by higher BMI Z-scores. Participants with assumed final height (based on age) had an average TBLH-BMD Z-score of 0.78 ± 1.06, significantly higher than references independent of gender, HbA1c, height- and weight Z-scores. Multiple regression analyses showed that TBLH BMD Z-score associated negatively to HbA1c (P = 0.003), pump treatment (P = 0.019) and screen-time (P = 0.005) and positively to weight Z-score (P < 0.001). Physical activity, sex and puberty did not significantly associate to TBLH-BMD Z-score.

Conclusion

Unlike adults with T1D, BMD is not decreased in children and adolescents with T1D and even elevated after attained final height. As HbA1c negatively associates to BMD, decreased BMD may progress over time. Whether changes in microarchitecture or bone metabolism precede changes in BMD needs further investigation.

Keywords

Bone mineral density Pediatrics Type 1 diabetes mellitus HbA1c 

Abbreviations

T1D

Type 1 diabetes mellitus

BMD

Bone mineral density

BMC

Bone mineral content

HbA1c

Glycated haemoglobin A1c

T2D

Type 2 diabetes mellitus

DXA

Dual energy X-ray absorptiometry

pQCT

Peripheral quantitative computed tomography

TBLH-BMD

Total body less head bone mineral density

fBG

Fasting blood glucose

PTH

Parathyroid hormone

ISCD

International Society of Clinical Densitometry

SD

Standard deviation

AIC

Akaike information criterion

CSII

Continuous subcutaneus insulin infusion

MDI

Multiple daily injections

BMI

Body mass index

Notes

Acknowledgements

Jette Høgsmose and Sussi Polmann for lending their expertise in blood sample acquisition and handling.

Author contributions

JOBM and JJ have designed the study and been the main writers of the article. AKJ have contributed with statistical help and understanding to optimize the statistics section. BZ and NRJ have contributed with expertise on bone health and bone examination in general. BSO and FP have been important parts of study development and design and finally CWH have gathered all data together with JOBM. All authors have contributed with proof-reading and constructive comments in putting together this manuscript.

Funding

This work was supported by Aase og Ejnar Danielssens fond (10-001544), Dronning Louises Børnehospitals fond, Vissing Fonden, Poul og Erna Sehested Hansens Fond (DK), Sehested Hansen Fonden and The research council at Herlev and Gentofte Hospital.

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest.

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Copyright information

© The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Jens Otto Broby Madsen
    • 1
  • Camilla Winther Herskin
    • 1
  • Bo Zerahn
    • 2
  • Andreas Kryger Jensen
    • 3
    • 4
  • Niklas Rye Jørgensen
    • 5
    • 6
  • Birthe Susanne Olsen
    • 1
  • Flemming Pociot
    • 1
    • 7
    • 8
  • Jesper Johannesen
    • 1
    • 7
    Email author
  1. 1.Department of Children AdolescentsCopenhagen University Hospital HerlevHerlevDenmark
  2. 2.Department of Nuclear Medicine, Herlev and Gentofte HospitalUniversity of CopenhagenHerlevDenmark
  3. 3.Section of Biostatistics, Institute of Public HealthUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of Clinical ResearchNordsjællands HospitalHillerødDenmark
  5. 5.Department of Clinical BiochemistryRigshospitaletGlostrupDenmark
  6. 6.OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  7. 7.Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  8. 8.Steno Diabetes Center CopenhagenGentofteDenmark

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