Girls with type 1 diabetes lose trabecular bone volume
Click Here to Manage Email Alerts
Adolescent girls with type 1 diabetes lost trabecular volumetric bone mineral density over 1 year compared with gains for girls without diabetes, with greater loss at higher HbA1c levels, according to a speaker.
“Childhood and adolescence are critical periods when rapid growth takes place and marked changes occur in bone mass, geometry and structure,” Ruban Dhaliwal, MD, MPH, associate professor of medicine in endocrinology, diabetes and metabolism, and director of the Metabolic Bone Disease Center at the State University of New York Upstate Medical University, and a research physician at Massachusetts General Hospital, told Healio. “Deborah Mitchell, MD, and colleagues had previously shown that girls with type 1 diabetes have lower trabecular bone volume compared with those without diabetes. Now we demonstrate that there is an ongoing decline in trabecular bone volume and deterioration of trabecular microarchitecture over the course of 1 year, and this bone loss compounds the preexisting deficit in trabecular bone.”
Researchers conducted a longitudinal study of 52 girls aged 10 to 16 years with type 1 diabetes (mean age, 13.6 years; 92.2% white). The type 1 diabetes group was matched for age, bone age, weight and height with 51 girls without diabetes. Participants were followed for 1 year. High-resolution peripheral quantitative CT was conducted at the distal radius and tibia, estimated bone strength was measured and trabecular morphology assessed with individual trabeculae segmentation at baseline and 1-year follow-up. Changes in skeletal outcomes from baseline to 1 year were assessed.
The findings were presented at the American Society for Bone and Mineral Research annual meeting.
At 1 year, the change in areal BMD was not different between the two groups. At the radius, girls with type 1 diabetes had a decline in trabecular volumetric BMD of –5 mg/cm3 compared with an increase in BMD of 0.2 mg/cm3 among those without diabetes (P = .036). The difference was due to a greater loss of plate-like trabeculae in girls with type 1 diabetes (beta = –12.8; P = .016). Trabecular volumetric BMD did not differ at the tibia between the groups.
When girls with type 1 diabetes were stratified by HbA1c, the loss of trabecular volumetric BMD at the radius tended to be larger among those with an HbA1c of greater than 8.5% compared with controls. Estimated failure load did not differ between those with diabetes and controls at the radius or tibia.
“Our data indicate that those with suboptimal glycemic control had a greater decline in trabecular bone volume,” Dhaliwal said. “This finding highlights the unfavorable impact of hyperglycemia on the growing skeleton of youth with type 1 diabetes and reiterates the importance of adequate glycemic control beyond vascular complications and early in the disease course.”
Perspective
Back to Top
Concerning data on the impact of type 1 diabetes on bone health in adolescent girls were presented by Ruban Dhaliwal, MD, MPH, at the September 2022 American Society for Bone and Mineral Research annual meeting. Her peripheral quantitative CT measurements of bone in girls with type 1 diabetes aged 10 to 16 years compared with control girls without diabetes over 1 year showed loss of trabecular bone volume and diminishing of trabecular bone architecture in the girls with diabetes. The effects were more profound in girls with poor glycemic control. Volumetric BMD of the trabeculae did not differ between the two groups. The strength of the study lies in how well matched the type 1 diabetes and control groups were for age, bone age and biometrics. A limitation of the study is that 92.2% of the participants were white.
These are worrisome findings, particularly occurring at an age when growth of bone would normally be occurring rapidly. A question for future study is whether this finding will be duplicated in the increasingly common situation of girls with type 2 diabetes. A mechanism for this phenomenon will also be of interest to determine, with possibilities including elevations in cortisol or suppression of the gonadal axis in girls with diabetes, direct effects of hyperglycemia or advanced glycation end products on the function of bone cells, and comorbid disordered eating.
Collapse
Dhaliwal R, et al. Oral Presentation 1086. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 9-12, 2022; Austin, Texas.
Click Here to Manage Email Alerts