Urinary calcium excretion linked to bone accrual for youths with type 1 diabetes
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Compared with healthy peers, a cohort of children and teens with type 1 diabetes accrued less bone over 12 months, particularly those with high urinary calcium excretion, making them more susceptible to fractures, according to study data.
“Our study provides further evidence that type 1 diabetes adversely affects bone accrual during childhood and adolescence,” David Weber, MD, MSCE, assistant professor of pediatrics at the Children’s Hospital of Philadelphia and adjunct professor of pediatrics at Golisano Children’s Hospital at the University of Rochester, told Healio. “A novel finding of this work is that urine calcium excretion was inversely associated with bone accrual.”
The findings were presented at the American Society for Bone and Mineral Research virtual meeting.
Weber and colleagues conducted an observational study of 53 youths aged 8 to 20 years (62% male; mean age, 14.9 years) who had type 1 diabetes for at least 1 year and no comorbidities. Participants underwent a DXA scan at baseline and 12-month follow-up to calculate bone mineral content of the whole body not including the head. Blood and urine tests were also completed at baseline and follow-up.
Researchers compared z scores for bone mineral content and bone accrual, adjusted for baseline bone mineral content, height, weight, lean body mass and puberty stage, with a healthy reference population.
The group had a mean decrease in bone mineral content z score from –0.16 at baseline to –0.21 at follow-up (P = .15). The mean bone mineral content velocity z score was lower for the study participants than the reference population (–0.31; P = .03).
Higher urinary calcium excretion values were associated lower bone accrual (Spearman rank, –0.49; P = .003). The associations did not change after adjustments for sex, puberty, growth velocity and biochemical markers of bone mineral metabolism. Six participants with hypercalciuria had a lower bone accrual z score than those without hypercalciuria (P = .02).
HbA1c was not associated with bone mineral content loss or urinary calcium excretion values, according to the researchers. Vitamin D, calcium intake and bone turnover markers were also not predictors for higher urinary calcium excretion.
Weber said the findings show that providers must be mindful that children with type 1 diabetes could have impaired bone health, especially during late adolescence.
“Clinicians caring for patients with type 1 diabetes need to be aware of the association between type 1 diabetes and bone health,” Weber said. “Patients with type 1 diabetes who have had an excessive number of fractures or unusual fractures should be evaluated further with DXA scan and markers of bone mineral metabolism, including urinary calcium.”
Weber said a future study is needed to examine whether high urinary calcium excretion is merely a marker of impaired bone accrual or directly associated.
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Weber DR, et al. Urinary calcium excretion is negatively associated with bone mineral accrual in youth with type 1 diabetes. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 11-15, 2020 (virtual meeting).
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