ESPE Abstracts

Background: Bone health impairment in patients with diabetes mellitus type 1 (DMT1) is already evident in pediatric age. Crucial moment is the time of attainment of peak bone mass which is also a window of opportunity for bone health interventions. Currently there are no detailed guidelines for screening/specific treatment of bone complications in DMT1.

Aim: To develop recommendations for screening and prevention of bone disorders based on our own results and literature review.

Materials and Methods: A cross-sectional study of 154 DMT1 patients and 70 controls. Assessment for bone turnover markers (osteocalcin, beta cross laps, bone alkaline phosphatase (bALP), Insulin-like Growth Factor-1 (IGF-1), bone metabolism (calcium, phosphorus, magnesium, parathormone (PTH), 25(OH)vitamin D, 24h calciuria, daily calcium intake) and cortical bone thickness of the metacarpals measured by digital X-ray radiogrammetry (Bone Health Index, BHI) was performed. Mean HbA1c -76 mmol/mol (9.12±1.64%), mean disease duration - 6.32 yrs±3.78.

Results: Patients have lower osteocalcin and beta cross laps levels compared to controls (63.89±35.19 ng/ml vs 79.28±40.65 ng/ml, р<0.001). Patients with lower HbA1c have more pronounced suppression of bone formation than those with good (60.16±31.41µg/L vs 90.93±18.42 for bALP). PTH, calcium and magnesium are also decreased (2.39 pmol/L±0.98 vs 2.89pmol/L±1.09, р< 0,05; 2.36±0.13mmol/L vs 2.41±0.11mmol/L, P <0.05 and 0.82±0.06 mmol/L vs 0.85±0.05mmol/L, P <0.01 respectively). In 24% there is significant calciuria (mean Ca/Cr -1.08±0.59mmol/mmol, P <0,001). No differences in vitamin D status (71.61±26.49 nmol/L vs 76.87±32.34 nmol/L, respectively P >0,05). In 20,37% (n = 11) of the examined patients (n = 54) there are decreased levels of BHI SDS (mean -2,82±0,69, P <0,05).

Conclusions: Patients with most severe changes, i.e suitable for screening:

- Prepubertal onset of DMT1

- Duration > 5 years

- HbA1c > 9%

- Мicrovascular complications

- Comorbidities (celiac disease, thyroid disease)

- Fracture

- Family history for osteoporosis

Screening tests should include:

- Dietary intake assessment

-Calcium-phosphorus metabolism - serum calcium, phosphorus, magnesium, PTH

- 25(OH)vitamin D

- Bone metabolism - bALP, osteocalcin, beta cross laps

- Calciuria

- BHI

Prevention should include:

- Good glycemic control

- Optimal nutritional intake

- Physical activity

- Тime outdoors

- Vitamin D supplementation

- Avoiding additional risk factors - smoking, alcohol etc.

We suggest monitoring once every 6 months in case of significant abnormalities or once a year if they are not present.

There is a need to incorporate bone screening in routine care for patients with DMT1, as well as more interventional studies.