Bone mineral density of the lumbar vertebrae in children and adolescents with insulin-dependent diabetes mellitus

Ponder, Stephen W.; McCormick, David P.; Fawcett, Heather; Tran, An; Ogelsby, Gerald W.; Brouhard, Ben H.; Travis, Luther B.

doi:10.1016/s0022-3476(05)82479-5

Cited by 59 publications

(29 citation statements)

References 21 publications

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“…In majority of earlier studies performed on type 1 diabetic population, both lumbar spine and hip BMD was decreased moderately. However, some studies reported normal hip BMD (22,23), and normal (24) or even increased spine BMD (25). Nevertheless, there is agreement that approximately 40-50% diabetic patients have decreased BMD and this decrease is independent of age, diabetes duration, presence of chronic microvascular complications, and the onset of diabetes (5,6,26), similar to our results.…”

Section: Discussionsupporting

confidence: 88%

Bone mineral density and hip structural analysis in type 1 diabetic men

Miazgowski

Pynka²,

Noworyta-Ziętara³

et al. 2007

eur j endocrinol

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Objective: The risk of non-vertebral fractures is increased in men with type 1 diabetes (DM1) but studies have shown only moderately decreased or normal bone mineral density (BMD) in these patients. No previous studies have evaluated hip strength and geometry indices in DM1 patients. This study was therefore designed to characterize associations between BMD, dual X-ray absorptiometry (DXA)-based hip strength indices, metabolic control, and DM1chronic complications. Design and methods: The study was performed on 36 males aged 43.6G5.1 years with long-lasting DM1 and 36 healthy males matched for age, weight, and height. BMD in lumbar spine, total hip, upper and lower part of the femoral neck, hip axis length, cross-sectional area and moment of inertia (CSMI), and glycated hemoglobin (HbA1c) were measured. Results: DM1 men had decreased spine BMD (P!0.05) and normal total hip BMD in comparison with controls. Hip geometry and strength indices were comparable in both groups. However, M1 men had decreased CSMI and upper femur BMD but these differences did not reach statistical significance (PZ0.06). BMD changes and hip strength parameters did not correlate with HbA1c. Conclusions: Middle-aged DM1 men have decreased lumbar spine BMD, normal hip BMD and normal hip strength indices. These changes are not influenced by metabolic control and presence of chronic microvascular complications.

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Section: Discussionsupporting

confidence: 88%

Bone mineral density and hip structural analysis in type 1 diabetic men

Miazgowski

Pynka²,

Noworyta-Ziętara³

et al. 2007

eur j endocrinol

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“…Although IGT (i.e., 2-h glucose Ն140 mg/dl) is an important precursor of diabetes (11), it is difficult to speculate the duration of this condition in our IGT children; nevertheless, we believe that inadequate duration of the pre-diabetic state may have contributed to the lack of significant differences in BMC and BMD of the two groups. Other research has shown that insulin-dependent diabetic children have a normal spine BMD during the first year of disease (16,17); a decreased BMD has been observed in those with long-standing diabetes (17). We are aware that there are also individual differences in susceptibility to disease; in other words, not all subjects with IGT will worsen to diabetes, and another possible explanation for the lack of significant differences in BMC and BMD between IGT and NGT may be because only IGT children with the potential to progress to diabetes may be at risk for osteopenia.…”

Section: Discussionmentioning

confidence: 99%

Impaired Glucose Tolerance and Bone Mineral Content in Overweight Latino Children With a Family History of Type 2 Diabetes

2005

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OBJECTIVE -Research on the skeletal status of pre-diabetic (type 2 diabetic) children is warranted. We examined the hypothesis that bone mineral content (BMC) and bone mineral density (BMD) will be lower in children with impaired glucose tolerance (IGT) versus normal glucose tolerance (NGT).RESEARCH DESIGN AND METHODS -Total body BMC and BMD of 184 overweight Latino children (106 boys, 78 girls, 11.9 Ϯ 1.7 years) with a family history of type 2 diabetes were measured using dual-energy X-ray absorptiometry. Glucose tolerance was assessed by 2-h glucose after an oral glucose tolerance test. Area under the insulin curve (AUC) assessed the cumulative insulin response to oral glucose. Acute insulin response to glucose (AIR) was determined by an intravenous glucose tolerance test.RESULTS -Partial correlations revealed an inverse relationship between BMC and AIR (r ϭ Ϫ0.29, P ϭ 0.00), AUC (r ϭ Ϫ0.28, P ϭ 0.00), fasting insulin (r ϭ Ϫ0.16, P ϭ 0.04), and 2-h insulin (r ϭ Ϫ0.16, P ϭ 0.04). There was no significant difference in BMC or BMD between children with IGT (n ϭ 46) or NGT (n ϭ 138). Stepwise multiple linear regression revealed that 89% of the variance in BMC is attributed to lean mass (87%), age (1%), and AIR (1%). BMD was explained by lean mass (69%), Tanner stage (3%), and AUC (2%).CONCLUSIONS -The findings of this study suggest that in overweight children, lean mass is the primary predictor of BMC and BMD, whereas age, Tanner stage, and the acute and cumulative insulin responses to oral glucose make subtle independent contributions to the total variances. In addition, poor glycemic control does not seem to be detrimental to bone mass of pre-diabetic children.

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“…Non-insulin-dependent diabetes has been associated with increased bone density (1-4), whereas insulindependent diabetes has been associated with decreased bone density (5)(6)(7)(8). A recent study comparing people with type 1 and type 2 diabetes with healthy control subjects confirmed lower bone mineral density in those with type 1 diabetes (23), a finding that could not be explained by insulin treatment.…”

Section: Methodsmentioning

confidence: 99%

“…In general, non-insulin-dependent diabetes has been associated with increased bone density, (1-4) whereas insulin-dependent diabetes has been associated with decreased bone density (5)(6)(7)(8). However, fewer studies have examined the risk of fracture in people with diabetes.…”

mentioning

confidence: 99%

Diabetes and Risk of Fracture

et al. 2001

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OBJECTIVE -To examine associations between measures of diabetes and risk of fracture in a population-based sample of older Australians.RESEARCH DESIGN AND METHODS -This was a prospective study of 3,654 subjects aged 49 years and older who were residents in the Blue Mountains, west of Sydney, Australia. At baseline, subjects were asked questions about history and treatment of diabetes, and fasting blood samples were taken. Photographs were taken of the retina and lens to grade retinopathy and cataract. Details of fractures (excluding rib and vertebral fractures) were collected by a combination of self-report and medical record searches; all fractures were radiologically confirmed.RESULTS -After 2 years of follow-up, we found that several diabetes-related factors were significantly associated (in multivariate models) with increased risk of all fractures combined, including presence of diabetic retinopathy (adjusted RR 5.4, 95% CI 2.7-10.8), diabetes duration Ն10 years (3.3, 1.3-8.2), cortical cataract involving Ն25% of the lens area (2.5, 1.3-4.7), and insulin treatment (5.9, 2.6 -13.5). The proximal humerus was the only individual fracture site associated with diabetes. Diabetic retinopathy (10.3, 2.2-48.0), diabetes duration (for Ն10 years duration; 11.4, 2.4 -54.2), and insulin treatment (18.8, 4.0 -88.7) were all associated with proximal humerus fracture.CONCLUSIONS -These data suggest a significantly increased risk of fracture associated with diabetic retinopathy, advanced cortical cataract, longer diabetes duration, and insulin treatment. However, there are some shortcomings in this study that may limit these findings.

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Bone mineral density of the lumbar vertebrae in children and adolescents with insulin-dependent diabetes mellitus

Cited by 59 publications

References 21 publications

Bone mineral density and hip structural analysis in type 1 diabetic men

Bone mineral density and hip structural analysis in type 1 diabetic men

Impaired Glucose Tolerance and Bone Mineral Content in Overweight Latino Children With a Family History of Type 2 Diabetes

Diabetes and Risk of Fracture

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