title: Lower bone mineral content in children with type 1 diabetes mellitus is linked to female sex, low insulin-like growth factor type I levels, and high insulin requirement.
abstract: BACKGROUND
  Studies on bone mineral characteristics in children with type 1 diabetes mellitus (T1DM) have generated conflicting results.
  
  
  OBJECTIVE
  Our objective was to investigate bone mineral characteristics in children with T1DM and to analyze their associations with bone metabolism and the IGF-I system.
  
  
  METHODS
  We recruited a cohort of Caucasian patients with T1DM for at least 3 yr and healthy children between January 2003 and June 2004.
  
  
  METHODS
  This was a university hospital-based study.
  
  
  METHODS
  A total of 127 patients and 319 controls aged 6 to 20 yr participated.
  
  
  METHODS
  Dual-energy x-ray absorptiometry was performed in patients and controls. Serum bone alkaline phosphatase, CrossLaps, IGF-I, and IGF-binding protein 3 levels were determined in patients with values analyzed using our normative data from 1150 healthy children.
  
  
  RESULTS
  After adjustment for age, sex, pubertal stage, and body mass index sd score, total body bone mineral content (BMC)/lean body mass was significantly lower in patients than in controls (P < 0.04). This difference was a result of the differences between the girls of the two groups. Girls with T1DM had significantly lower lumbar spine and total body BMC than control girls (P = 0.002), whereas no such difference was observed in boys. Serum bone alkaline phosphatase level was significantly lower in girls than in boys (P = 0.04). Low serum IGF-I levels and the administration of large amounts of insulin were found to have independent deleterious effects on BMC for children of all ages and both sexes, whereas disease duration and glycosylated hemoglobin levels did not.
  
  
  CONCLUSIONS
  A sex-related difference in the impairment of bone mineral characteristics was identified in children with T1DM. Longitudinal studies are required to investigate whether boys may gain slightly less bone mass during skeletal growth.
authors.affiliation: Pediatric Endocrinology Unit and INSERM U 690, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France. juliane.leger@rdb.ap-hop-paris.fr
authors.forename: Juliane
authors.initials: J
authors.lastname: Léger
authors.forename: Daniela
authors.initials: D
authors.lastname: Marinovic
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Sophie
authors.initials: S
authors.lastname: Dorgeret
authors.forename: Didier
authors.initials: D
authors.lastname: Chevenne
authors.forename: Claire Lévy
authors.initials: CL
authors.lastname: Marchal
authors.forename: Nadia
authors.initials: N
authors.lastname: Tubiana-Rufi
authors.forename: Guy
authors.initials: G
authors.lastname: Sebag
authors.forename: Paul
authors.initials: P
authors.lastname: Czernichow
mesh_terms: D000293:Adolescent; D000328:Adult; D001823:Body Composition; D015519:Bone Density; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I