Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Schepper, Jean De; Smitz, Johan; Rosseneu, S. L. M.; Bollen, Peter; Louis, Olivia

doi:10.1159/000023273

Cited by 49 publications

(72 citation statements)

References 21 publications

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“…In a follow-up study on patients with mean Ϯ SD disease (25,26). In analogy to our results, the effect of metabolic control on BMD and bone mass development has been excluded by several authors (6,27). The A1C values in our patient population were quite satisfactory and comparable to those in a German type 1 diabetic patient population of the same age (19).…”

Section: Influencing Factorssupporting

confidence: 89%

See 1 more Smart Citation

Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes

Bechtold¹,

Putzker²,

Bonfig³

et al. 2007

Diabetes Care

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OBJECTIVE -The aim of this study was to establish whether type 1 diabetes has a long-term effect on bone development in children and adolescents.RESEARCH DESIGN AND METHODS -Bone characteristics and muscle crosssectional area (CSA) were analyzed cross-sectionally in 41 (19 female and 22 male) patients and were reevaluated after 5.56 Ϯ 0.4 years using peripheral quantitative computed tomography (pQCT). We hypothesize that bone size and muscle mass normalize with age.RESULTS -At the first evaluation, mean Ϯ SD age was 9.87 Ϯ 2.3 years and disease duration was 4.31 Ϯ 2.9 years. Height was Ϫ0.36 Ϯ 1.9 SD, and BMI was 0.39 Ϯ 0.9 SD. Parameters of bone size were low in the whole patient group (corrected for patient's height). At reevaluation, age was 15.44 Ϯ 2.3 years, and patients had a mean height of Ϫ0.12 Ϯ 0.8 SD. BMI SD had increased to 0.57 Ϯ 1.1. Total and cortical CSA had normalized. Those patients with an increase in total CSA had a significant younger age at disease manifestation and a younger age at initial pQCT measurement. Bone size was well adapted to muscle mass expressed as the ratio of bone mineral content per muscle mass, and a close correlation was shown between the increase in bone size and in muscle CSA (r ϭ 0.46, P ϭ 0.03).CONCLUSIONS -Patients with manifestation of type 1 diabetes at an early age had transient impaired bone development. Within the follow-up period, the greatest increase in bone size was found in these patients. In adolescence, all patients had a normal bone size and appropriate adaptation of bone on muscle. There are still no conclusive data on the relative importance of several diabetesspecific characteristics, such as age at onset, disease duration, and glycemic control or insulin regimen, on bone health (6). Diabetes CareThe majority of earlier studies were cross-sectional using dual-energy X-ray absorptiometry of the spine. In pediatric patients, in particular, this method has l i m i t a t i o n s b e c a u s e o f t h e t w odimensional measurement and therefore height dependency. Longitudinal data on relatively small numbers of patients over 2-4 years revealed disturbed or normal bone development (7,8). A recently published study over a wide time range from 12 to 84 months showed slightly reduced mineralization of the spine independent of metabolic control or microvascular complications (9). The incidence of bone fractures was not increased in a large adult population with type 1 diabetes (10). Therefore, the clinical importance of possibly lower bone mineralization in type 1 diabetes is not clear.The objectives of the present longitudinal study were to evaluate bone mineral density (BMD) and bone size and muscle mass in patients with type 1 diabetes at two time points (5.5 years apart) using peripheral quantitative computed tomography (pQCT). Interpretation of BMD and geometry measurements is incomplete without taking into account muscle mass (11). Therefore, we looked at the ratio between bone mineral content (BMC) and muscle mass (12). RESEARCH DESIGN ANDMETHODS -In a ...

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Section: Influencing Factorssupporting

confidence: 89%

“…There are still no conclusive data on the relative importance of several diabetesspecific characteristics, such as age at onset, disease duration, and glycemic control or insulin regimen, on bone health (6).…”

mentioning

confidence: 99%

Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes

Bechtold¹,

Putzker²,

Bonfig³

et al. 2007

Diabetes Care

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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: 95%

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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“…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. Bone loss was found even in children, at the time of diagnosis (6,27). This may suggest that bone loss in type 1 diabetic men may not be viewed as part of constellation of known chronic, microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy) but rather two distinct outcomes related to diabetes progression.…”

Section: Discussionmentioning

confidence: 99%

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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Lumbar Spine Bone Mineral Density in Diabetic Children with Recent Onset

Cited by 49 publications

References 21 publications

Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes

Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes

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

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

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