Bone mineral density and alterations of bone metabolism in children and adolescents with type 1 diabetes mellitus.
OBJECTIVE
To analysis bone mineral density (BMD) and bone turnover markers in children and adolescents with type 1 diabetes mellitus (DM1) and to establish possible correlations with duration of the disease and degree of metabolic control.


METHODS
Fifty-eight (26 prepubertal, 32 pubertal) children (29 boys) with DM1 (age: 11.7 +/- 3.1 years) and 44 (20 prepubertal, 24 pubertal) healthy children (21 boys) as controls (age: 10.8 +/- 3.2 years) were included in the study. BMD was measured by dual energy X-ray absorptiometry (DEXA). Scans of the lumbar spine (LS2-4) and femoral neck (FN) were carried out. Serum levels of osteocalcin, amino-terminal propeptide of type I procollagen (PINP), and alkaline phosphatase, as markers of bone formation, and urinary calcium/creatinine (Ca/Cr) ratio and levels of N-telopeptide (Ntx), as markers of bone resorption, were assessed. Anthropometrics, duration of DM1, presence of complications, insulin dose, and degree of metabolic control were obtained from the patients' records.


RESULTS
In children with DM1 and controls, the mean measurements of LS2-4 BMD were 0.698 +/- 0.178 g/cm2 and 0.669 +/- 0.192 g/cm2, respectively (p >0.05), and FN-BMD measurements were 0.743 +/- 0.147 g/cm2 and 0.744 +/- 0.170 g/cm2, respectively (p >0.05). Children with DM1 had lower serum levels of calcium, intact parathyroid hormone, osteocalcin and PINP, and higher serum levels of 25-hydroxyvitamin D and urinary Ca/Cr (p <0.05). BMD was not related to any of the markers of bone resorption or formation, duration of the disease, or degree of metabolic control.


CONCLUSIONS
Although we did not establish decreased LS2-4 and FN-BMD measurements in patients with DM1, we found reduced bone formation and increased bone resorption markers in children with DM1. Measurements of serum osteocalcin, PINP, urinary Ntx and Ca/Cr might be useful for long-term follow-up in children and adolescents with DM1.
Karagüzel
Gülay
G
Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Akdeniz University, Antalya, Turkey. gulaykg@akdeniz.edu.tr
Akçurin
Sema
S
Ozdem
Sebahat
S
Boz
Adil
A
Bircan
Iffet
I
D015502:Absorptiometry, Photon; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D001846:Bone Development; D001862:Bone Resorption / Q000097:blood; D001842:Bone and Bones / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging; D008297:Male; D010012:Osteogenesis
D015415:Biomarkers