title: Bone status of Indian children and adolescents with type 1 diabetes mellitus.
abstract: OBJECTIVE
  Low bone mineral density has been reported in children and adolescents with type 1 diabetes (T1DM). The aims of this cross-sectional study were to study growth, serum IGF1 concentrations and bone health parameters assessed by Dual Energy X-ray Absorptiometry (DXA).
  
  
  METHODS
  Height was measured and converted to Z scores (HAZ). Serum IGF1 concentrations were measured (ELISA) in a subset. Bone mineral content for total body (less head) (TBBMC) and lumbar spine was measured (n=170, 77 boys, 6-16years old) and converted to Z scores using local normative data.
  
  
  RESULTS
  Mean age was 11.1±3.8years, disease duration was 2.2±2.5years and HbA1C was 10.1±1.8%. Diabetic children were shorter than reference population (HAZ -0.6±1.1); Z scores for height and total body bone area (TBBA) for height were <-2SD in 12% & 6% respectively. Serum IGF1 Z scores were lower amongst group with longer disease duration (-1.58±1.3 vs -2.63±0.7; P=0.037). Disease duration (β=-0.180, P=0.000) and metabolic control (HbA1C; β=-0.096, P=0.042) were negative predictors of HAZ and TBBA for height Z in younger children. Using the Molgaard approach, children with longer disease duration had lower HAZ (-0.31±0.92 vs -1.28±1.11; P=0.000; "short bones") and TBBA for height Z scores (0.12±1.62 vs -0.53±0.94; P=0.044; "slender bones"). Older children (tanner stages 4 and 5) had lower BMC and BA as compared to reference population possibly due to delayed growth spurt.
  
  
  CONCLUSIONS
  Longer duration of diabetes was associated with shorter and slender but appropriately mineralized bones. Small and slender bones in diabetic children may increase risk of fragility fractures in the future. This article is part of a Special Issue entitled "Bone and diabetes".
authors.affiliation: Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India. Electronic address: parthasarathy.lavanya@gmail.com.
authors.forename: Lavanya S
authors.initials: LS
authors.lastname: Parthasarathy
authors.affiliation: Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India. Electronic address: vamankhadilkar@gmail.com.
authors.forename: Vaman V
authors.initials: VV
authors.lastname: Khadilkar
authors.affiliation: Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India. Electronic address: drsjc_1@yahoo.com.
authors.forename: Shashi A
authors.initials: SA
authors.lastname: Chiplonkar
authors.affiliation: Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK. Electronic address: zulf.mughal@cmft.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Zulf Mughal
authors.affiliation: Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India. Electronic address: anuradhavkhadilkar@gmail.com.
authors.forename: Anuradha V
authors.initials: AV
authors.lastname: Khadilkar
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D001827:Body Height / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male
keywords: Bone density; Children; IGF1; Type 1 diabetes