Bone Geometry, Quality, and Bone Markers in Children with Type 1 Diabetes Mellitus


Adults with Type 1 diabetes mellitus show a high risk of bone fracture, probably as a consequence of a decreased bone mass and microarchitectural bone alterations. The aim of the study was to investigate the potential negative effects of type 1 diabetes on bone geometry, quality, and bone markers in a group of children and adolescents. 96 children, mean age 10.5 ± 3.1 years, agreed to participate to the study. Bone geometry was evaluated on digitalized X-rays at the level of the 2nd metacarpal bone. The following parameters were investigated and expressed as SDS: outer diameter (D), inner diameter (d), cortical area (CA), and medullary area (MA). Bone strength was evaluated as Bending Breaking Resistance Index (BBRI) from the geometric data. Bone turnover markers (PINP, CTX-I, and BAP), sclerostin, Dkk-1, PTH, and 25OH-Vitamin D were also assessed. A group of healthy 40 subjects of normal body weight and height served as controls for the bone markers. D (− 0.99 ± 0.98), d (− 0.41 ± 0.88), CA (− 0.85 ± 0.78), and MA (− 0.46 ± 0.78) were all significantly smaller than in controls (p < 0.01). BBRI was significantly lower (− 2.61 ± 2.18; p < 0.0001). PTH, PINP, and BAP were higher in the diabetic children. Multiple regression analysis showed that CA and D were influenced by insulin/Kg/day and by BMI, while d was influenced by PINP only. Type 1 diabetic children show smaller and weaker bones. The increased bone turnover could play a key role since it might amplify the deficit in bone strength associated with the inadequate osteoblastic activity caused by the disease itself.

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The authors would like to thank Caterina Fraccarollo for ELISA assays and the LURM (Laboratorio Universitario di Ricerca Medica) Research Centre of University of Verona, where this study was partially performed.

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Correspondence to Giorgio Radetti.

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Conflict of interest

(Roberto Franceschi, Silvia Longhi, Vittoria Cauvin, Angelo Fassio, Giuseppe Gallo, Fiorenzo Lupi, Petra Reinstadler, Antonio Fanolla, Davide Gatti, and Giorgio Radetti) have no financial conflicts of interest. The authors have full control of all primary data and they agree to allow the journal to review their data if requested.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Franceschi, R., Longhi, S., Cauvin, V. et al. Bone Geometry, Quality, and Bone Markers in Children with Type 1 Diabetes Mellitus. Calcif Tissue Int 102, 657–665 (2018).

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  • Bone geometry
  • Bone quality
  • Bone markers
  • Children
  • Sclerostin
  • Dkk-1