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Lower bone mineral density in children with type 1 diabetes is associated with poor glycemic control and higher serum ICAM-1 and urinary isoprostane levels

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Abstract

The purpose of the study was to investigate bone mineral density (BMD) in children with type 1 diabetes (DM1) and to establish the relationships between BMD, physical activity, glycemic control, and markers of systemic oxidative stress and inflammation. We studied 30 children with DM1, aged 4.7–18.6 years, and 30 healthy subjects, matched by sex, age, and body mass index (BMI). Mean duration of DM1 was 5.4 ± 3.4 years and mean glycosylated hemoglobin (HbA1c) level over 12 months was 9.8 ± 1.5%. Lumbar and total bone mineral density (BMD, g/cm2) were measured by dual-energy X-ray absorptiometry (DXA). We calculated the apparent volumetric lumbar BMD (BMDvol, g/cm3) and total mineral content adjusted for age and height (BMCadj), and measured plasma intercellular adhesion molecule-1 (ICAM-1), high sensitivity C-reactive protein (hs-CRP), and urinary 8-iso-prostaglandin F2a (F2-IsoPs). Calcium (Ca) intake was assessed by questionnaire and physical activity by questionnaire and accelerometer (ActiGraph, count/h). Total BMCadj and lumbar BMDvol were significantly lower in children with DM1 than in controls (101.8 ± 7.7 vs. 107 ± 5.7%, P = 0.005; 0.32 ± 0.08 vs. 0.36 ± 0.09 g/cm3, P = 0.05, respectively). These differences were mostly caused by the differences in boys. Plasma ICAM-1 and hs-CRP levels were significantly higher in the DM1 group compared to the controls. Ca intake and urine F2-IsoPs levels were similar between the groups. Diabetic boys were less active than controls (18231 ± 6613 vs. 24145 ± 7449 count/h, P = 0.04). In the DM1 group, lumbar BMDvol correlated inversely with urinary F2-IsoPs (r = −0.5; P = 0.005) and plasma ICAM-1 levels (r = −0.4; P = 0.02), and also with HbA1c levels after adjustment for age (r = −0.45; P < 0.05). Total BMCadj correlated inversely with HbA1c levels (r = −0.4; P = 0.02). We conclude that children with DM1, particularly boys, have lower BMD. Poor glycemic control, elevated markers of oxidative stress, and inflammation are associated with lower BMD.

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Acknowledgments

This study was funded by Estonian Science Foundation Grant Nr. 6588, the targeted financed grants SF0182695s05 and SF0180105s08 from the Ministry of Science and Education. Support was also given by the European Union through the European Regional Development Fund.

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Authors and Affiliations

  1. Department of Paediatrics, University of Tartu, 6 Lunini Street, Tartu, 51014, Estonia

    Kaire Heilman & Vallo Tillmann

  2. Department of Biochemistry, Centre of Molecular and Clinical Medicine, University of Tartu, Tartu, Estonia

    Mihkel Zilmer & Kersti Zilmer

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  1. Kaire Heilman
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Correspondence to Kaire Heilman.

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Heilman, K., Zilmer, M., Zilmer, K. et al. Lower bone mineral density in children with type 1 diabetes is associated with poor glycemic control and higher serum ICAM-1 and urinary isoprostane levels. J Bone Miner Metab 27, 598–604 (2009). https://doi.org/10.1007/s00774-009-0076-4

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  • DOI: https://doi.org/10.1007/s00774-009-0076-4

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