title: Reduced Bone Mineral Density Is Associated with Celiac Disease Autoimmunity in Children with Type 1 Diabetes.
abstract: OBJECTIVE
  To evaluate the association between bone mineral density (BMD), glycemic control (hemoglobin A1c [HbA1c]), and celiac autoimmunity in children with type 1 diabetes mellitus (T1D) and in an appropriate control population.
  
  
  METHODS
  BMD was assessed cross-sectionally in 252 children with T1D (123 positive for anti-tissue transglutaminase antibody [tTGA] and 129 matched children who were negative for tTGA). In addition, BMD was assessed in 141 children without diabetes who carried T1D-associated HLD-DR, DQ genotypes (71 positive for tTGA and 70 negative).
  
  
  RESULTS
  Children with T1D who were positive for tTGA had significantly worse BMD L1-L4 z-score compared with children with T1D who were negative for tTGA (-0.45 ± 1.22 vs 0.09 ± 1.10, P = .0003). No differences in growth measures, urine N-telopeptides, 25-hydroxyvitamin D, ferritin, thyroid stimulating hormone, or HbA1c were found. However, both higher HbA1c (β = -1.25 ± 0.85, P = .0016) and tTGA (β = -0.13 ± 0.05, P = .0056) were significant and independent predictors of lower BMD in multivariate analyses. No differences in BMD or other variables measured were found between children without diabetes who were positive vs negative for tTGA.
  
  
  CONCLUSIONS
  The results suggest a synergistic effect of hyperglycemia and celiac autoimmunity on low BMD.
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Kimber M
authors.initials: KM
authors.lastname: Simmons
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
authors.forename: Kim
authors.initials: K
authors.lastname: McFann
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Iman
authors.initials: I
authors.lastname: Taki
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
authors.forename: Edwin
authors.initials: E
authors.lastname: Liu
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Rewers
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO. Electronic address: brigitte.frohnert@ucdenver.edu.
authors.forename: Brigitte I
authors.initials: BI
authors.lastname: Frohnert
mesh_terms: D000293:Adolescent; D015551:Autoimmunity; D015519:Bone Density; D002446:Celiac Disease / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male
chemical_list: D006442:Glycated Hemoglobin