Background: Type 1 Diabetes (T1D) is associated with increased fracture risk.
Aim: Understand the association between glycaemic control and bone health in children with T1D.
Method: Children (n, 32) with T1D and a median (range) age of 13.7 years (10.4,16.4), were recruited to study bone mineral content (TB & LS) and body composition by DXA. All data were corrected for size. Vitamin D, Bone alkaline phosphatase (BAP) and C-terminal cross-linked telopeptides (CTX) were measured and converted to SDS. Anthropometry, disease details, xray-confirmed fracture history, HbA1c over the previous 12 months and physical activity scores were recorded.
Results: The median HbA1c was 65 mmol/mol (27,100). TB and LS BMC SDS was −0.1 (−1.1, 0.9) and LS −0.3(−1.0, 1.8), both lower than average for local normative data (P=0.02, and P=0.01, respectively). BMC SDS did not show any correlation to glycaemic control, age at diagnosis, or disease duration. However, vitamin D levels were associated with LS BMC SDS (r,−0.4, P=0.03). The cohort had a low median BAP SDS and CTX SDS of −0.57 (−2.5, 8.7) and −1.05 (−2.49, 0.51), respectively (P<0.01). CTX was inversely related to TB BMC SDS (r, −0.5, P<0.01). A lower BAP was more likely in those with a HbA1c of >65 mmol/mol. Of 32, 10 had suffered a fracture after the diagnosis and the fracture group had a HbA1c of 72 mmol/mol (49,100) vs 62 mmol/mol (27,87) in the non-fracture group (P<0.01). The TB BMC SDS in the fracture and non-fracture groups was −0.5 (−1, −1.8) and 0 (−0.5, 0.9), respectively (P<0.01). There was no difference in the body composition of these two groups and the physical activity score was higher in the fracture group (P=0.04).
Conclusion: Children with T1D display a low bone turnover state and marginally low bone mineral status. Those who suffer a fracture are likely to have a worse bone mineral status and glycaemic control.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology