School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Diabetes Care. 2021 Aug;44(8):1898-1905. doi: 10.2337/dc20-3128. Epub 2021 Jul 20.
There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent.
To perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or quantitative ultrasound (QUS).
PubMed, Embase, Scopus, and Web of Science from 1 January 1990 to 31 December 2020, limited to humans, without language restriction.
Inclusion criteria were as follows: cross-sectional or cohort studies that included BMD measured by DXA, pQCT, or QUS in youth (aged <20 years) with type 1 diabetes and matched control subjects.
We collected data for total body, lumbar spine, and femoral BMD (DXA); tibia, radius, and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference was estimated and meta-regression was performed with age, diabetes duration, and HbA as covariates.
We identified 1,300 nonduplicate studies; 46 met the inclusion criteria, including 2,617 case and 3,851 control subjects. Mean ± SD age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: total body (WMD -0.04 g/cm, 95% CI -0.06 to -0.02; = 0.0006), lumbar spine (-0.02 g/cm, -0.03 to -0.0; = 0.01), femur (-0.04 g/cm, -0.05 to -0.03; < 0.00001), tibial trabecular (-11.32 g/cm, -17.33 to -5.30; = 0.0002), radial trabecular (-0.91 g/cm, -1.55 to -0.27; = 0.005); phalangeal (-0.32 g/cm, -0.38 to -0.25; < 0.00001), and calcaneal (standardized mean difference -0.69 g/cm, -1.11 to -0.26; = 0.001). With use of meta-regression, total body BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031; = 0.002) but not with longer diabetes duration or HbA.
Meta-analysis was limited by the small number of studies with use of QUS and pQCT and by lack of use of BMD scores in all studies.
Bone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.
大量证据表明 1 型糖尿病患者的骨矿物质密度（BMD）降低；然而，在年轻人中的发现并不一致。
使用 DXA、外周定量计算机断层扫描（pQCT）和/或定量超声（QUS）对 1 型糖尿病青少年的 BMD 进行系统评价和荟萃分析。
1990 年 1 月 1 日至 2020 年 12 月 31 日，PubMed、Embase、Scopus 和 Web of Science 数据库，仅限于人类，无语言限制。
纳入标准如下：横断面或队列研究，包括通过 DXA、pQCT 或 QUS 测量的 1 型糖尿病青少年（年龄<20 岁）和匹配的对照组的 BMD。
我们收集了全身、腰椎和股骨 BMD（DXA）；胫骨、桡骨和腰椎（pQCT）；以及指骨和跟骨（QUS）的数据。估计加权均数差（WMD）或标准化均数差，并使用年龄、糖尿病病程和 HbA 作为协变量进行荟萃回归分析。
我们确定了 1300 篇非重复研究；其中 46 项符合纳入标准，包括 2617 例病例和 3851 例对照。平均±标准差年龄为 12.6±2.3 岁。1 型糖尿病青少年的 BMD 较低：全身（WMD-0.04g/cm，95%CI-0.06 至-0.02； = 0.0006）、腰椎（-0.02g/cm，-0.03 至-0.00； = 0.01）、股骨（-0.04g/cm，-0.05 至-0.03； < 0.00001）、胫骨小梁（-11.32g/cm，-17.33 至-5.30； = 0.0002）、桡骨小梁（-0.91g/cm，-1.55 至-0.27； = 0.005）；指骨（-0.32g/cm，-0.38 至-0.25； < 0.00001）和跟骨（标准化均数差-0.69g/cm，-1.11 至-0.26； = 0.001）。使用荟萃回归，全身 BMD 与年龄较大（系数-0.0063，-0.0095 至-0.0031； = 0.002）有关，但与糖尿病病程较长或 HbA 无关。
荟萃分析受到使用 QUS 和 pQCT 的研究数量较少以及所有研究中未使用 BMD 评分的限制。
1 型糖尿病青少年的骨骼发育异常，通过多种方式评估。所有 1 型糖尿病青少年均应考虑常规评估 BMD。
