Parthasarathy Lavanya S, Khadilkar Vaman V, Chiplonkar Shashi A, Zulf Mughal M, Khadilkar Anuradha V
Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.
Bone. 2016 Jan;82:16-20. doi: 10.1016/j.bone.2015.04.050. Epub 2015 May 5.
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).
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.
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.
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".
据报道，1型糖尿病（T1DM）儿童和青少年存在低骨矿物质密度。本横断面研究的目的是研究生长情况、血清胰岛素样生长因子1（IGF1）浓度以及通过双能X线吸收法（DXA）评估的骨骼健康参数。
测量身高并转换为Z评分（身高别年龄Z评分，HAZ）。对一部分儿童测量血清IGF1浓度（酶联免疫吸附测定法，ELISA）。测量170名6至16岁儿童（77名男孩）的全身（不含头部）骨矿物质含量（TBBMC）和腰椎骨矿物质含量，并使用当地正常参考数据将其转换为Z评分。
平均年龄为11.1±3.8岁，病程为2.2±2.5年，糖化血红蛋白（HbA1C）为10.1±1.8%。糖尿病儿童比参考人群矮（HAZ -0.6±1.1）；身高Z评分和身高别全身骨面积（TBBA）Z评分分别有12%和6%低于-2标准差。病程较长的儿童血清IGF1 Z评分较低（-1.58±1.3对-2.63±0.7；P=0.037）。病程（β=-0.180，P=0.000）和代谢控制情况（HbA1C；β=-0.096，P=0.042）是年幼儿童HAZ和身高别TBBA Z评分的负向预测因素。采用莫尔加德方法，病程较长的儿童HAZ较低（-0.31±0.92对-1.28±1.11；P=0.000；“短骨”），身高别TBBA Z评分也较低（0.12±1.62对-0.53±0.94；P=0.044；“细骨”）。与参考人群相比，年龄较大的儿童（ Tanner分期4期和5期）骨矿物质含量和骨面积较低，可能是由于生长突增延迟。
糖尿病病程较长与骨骼短小纤细但矿化适当有关。糖尿病儿童骨骼细小可能会增加未来发生脆性骨折的风险。本文是名为“骨骼与糖尿病”的特刊的一部分。
