Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom.
Paediatric Diabetes Service, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom.
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3585-3594. doi: 10.1210/jc.2019-00084.
Type 1 diabetes (T1D) is associated with an increased fracture risk at all ages.
To understand the determinants of bone health and fractures in children with T1D.
Case-control study of children with T1D on bone-turnover markers, dual-energy X-ray absorptiometry, and 3 Tesla-MRI of the proximal tibia to assess bone microarchitecture and vertebral marrow adiposity compared with age- and sex-matched healthy children.
Thirty-two children with T1D at a median (range) age of 13.7 years (10.4, 16.7) and 26 controls, aged 13.8 years (10.2, 17.8), were recruited. In children with T1D, serum bone-specific alkaline phosphatase (BAP) SD score (SDS), C-terminal telopeptide of type I collagen SDS, and total body (TB) and lumbar spine bone mineral density (BMD) SDS were lower (all P < 0.05). Children with T1D also had lower trabecular volume [0.55 (0.47, 0.63) vs 0.59 (0.47, 0.63); P = 0.024], lower trabecular number [1.67 (1.56, 1.93) vs 1.82 (1.56, 1.99); P = 0.004], and higher trabecular separation [0.27 (0.21, 0.32) vs 0.24 (0.20, 0.33); P = 0.001] than controls. Marrow adiposity was similar in both groups (P = 0.25). Bone formation, as assessed by BAP, was lower in children with poorer glycemic control (P = 0.009) and who were acidotic at initial presentation (P = 0.017) but higher in children on continuous subcutaneous insulin infusion (P = 0.025). Fractures were more likely to be encountered in children with T1D compared with controls (31% vs 19%; P< 0.001). Compared with those without fractures, the T1D children with a fracture history had poorer glycemic control (P = 0.007) and lower TB BMD (P < 0.001) but no differences in bone microarchitecture.
Children with T1D display a low bone-turnover state with reduced bone mineralization and poorer bone microarchitecture.
1 型糖尿病（T1D）与各年龄段的骨折风险增加有关。
了解 T1D 患儿骨健康和骨折的决定因素。
对骨转换标志物、双能 X 射线吸收法和 3 特斯拉磁共振成像进行评估，以比较儿童 T1D 与年龄和性别匹配的健康儿童的胫骨近端骨微结构和椎体骨髓脂肪含量的病例对照研究。
纳入 32 名中位（范围）年龄为 13.7 岁（10.4，16.7）的 T1D 患儿和 26 名对照，年龄为 13.8 岁（10.2，17.8）。T1D 患儿血清骨特异性碱性磷酸酶（BAP）SD 评分（SDS）、I 型胶原 C 端肽 SDS、全身（TB）和腰椎骨密度（BMD）SDS 均较低（均 P<0.05）。T1D 患儿的骨小梁体积[0.55（0.47，0.63）vs 0.59（0.47，0.63）；P=0.024]、骨小梁数量[1.67（1.56，1.93）vs 1.82（1.56，1.99）；P=0.004]和骨小梁间距[0.27（0.21，0.32）vs 0.24（0.20，0.33）；P=0.001]均较低，骨髓脂肪含量在两组间相似（P=0.25）。BAP 评估的骨形成在血糖控制较差（P=0.009）和初始表现时酸中毒（P=0.017）的患儿中较低，但在持续皮下胰岛素输注（P=0.025）的患儿中较高。与对照组相比，T1D 患儿更易发生骨折（31%比 19%；P<0.001）。与无骨折史的患儿相比，有骨折史的 T1D 患儿血糖控制较差（P=0.007），TB BMD 较低（P<0.001），但骨微结构无差异。
T1D 患儿表现为低骨转换状态，骨矿化减少，骨微结构较差。
