College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2.
College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2; College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5.
Bone. 2022 Oct;163:116509. doi: 10.1016/j.bone.2022.116509. Epub 2022 Jul 29.
Deficits in bone mineral and weaker bone structure in children with type 1 diabetes (T1D) may contribute to a lifelong risk of fracture. However, there is no meta-analysis comparing bone properties beyond density between children with T1D and typically developing children (TDC). This meta-analysis aimed to assess differences and related factors in bone mineral content (BMC), density, area, micro-architecture and estimated strength between children with T1D and TDC. We systematically searched MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cochrane Library databases, and included 36 in the meta-analysis (2222 children and youth with T1D, 2316 TDC; mean age ≤18 yrs., range 1-24). We estimated standardized mean differences (SMD) using random-effects models and explored the role of age, body size, sex ratio, disease duration, hemoglobin A1c in relation to BMC and areal density (aBMD) SMD using meta-regressions. Children and youth with T1D had lower total body BMC (SMD: -0.21, 95% CI: -0.37 to -0.05), aBMD (-0.30, -0.50 to -0.11); lumbar spine BMC (-0.17, -0.28 to -0.06), aBMD (-0.20, -0.32 to -0.08), bone mineral apparent density (-0.30, -0.48 to -0.13); femoral neck aBMD (-0.21, -0.33 to -0.09); distal radius and tibia trabecular density (-0.38, -0.64 to -0.12 and -0.35, -0.51 to -0.18, respectively) and bone volume fraction (-0.33, -0.56 to -0.09 and -0.37, -0.60 to -0.14, respectively); distal tibia trabecular thickness (-0.41, -0.67 to -0.16); and tibia shaft cortical content (-0.33, -0.56 to -0.10). Advanced age was associated with larger SMD in total body BMC (-0.13, -0.21 to -0.04) and aBMD (-0.09; -0.17 to -0.01) and longer disease duration with larger SMD in total body aBMD (-0.14; -0.24 to -0.04). Children and youth with T1D have lower BMC, aBMD and deficits in trabecular density and micro-architecture. Deficits in BMC and aBMD appeared to increase with age and disease duration. Bone deficits may contribute to fracture risk and require attention in diabetes research and care. STUDY REGISTRATION: PROSPERO (CRD42020200819).
1 型糖尿病儿童的骨矿物质和骨结构减弱可能导致其终生骨折风险增加。然而，目前尚无荟萃分析比较 1 型糖尿病儿童和正常发育儿童（TDC）的骨特性，除了密度以外。本荟萃分析旨在评估 1 型糖尿病儿童和 TDC 之间骨矿物质含量（BMC）、密度、面积、微观结构和估计强度的差异及相关因素。我们系统地检索了 MEDLINE、Embase、CINAHL、Web of Science、Scopus 和 Cochrane 图书馆数据库，并纳入了 36 项荟萃分析（2222 名 1 型糖尿病儿童和青少年，2316 名 TDC；平均年龄≤18 岁，范围 1-24 岁）。我们使用随机效应模型估计标准化均数差值（SMD），并使用荟萃回归探讨年龄、体型、性别比例、疾病持续时间、血红蛋白 A1c 与 BMC 和面积密度（aBMD）SMD 的关系。1 型糖尿病儿童和青少年的全身 BMC（SMD：-0.21，95%CI：-0.37 至-0.05）、aBMD（SMD：-0.30，-0.50 至-0.11）、腰椎 BMC（SMD：-0.17，-0.28 至-0.06）、aBMD（SMD：-0.20，-0.32 至-0.08）、骨矿物质表观密度（SMD：-0.30，-0.48 至-0.13）、股骨颈 aBMD（SMD：-0.21，-0.33 至-0.09）、桡骨远端和胫骨小梁密度（SMD：-0.38，-0.64 至-0.12 和-0.35，-0.51 至-0.18）和骨体积分数（SMD：-0.33，-0.56 至-0.09 和-0.37，-0.60 至-0.14）、胫骨远端小梁厚度（SMD：-0.41，-0.67 至-0.16）和胫骨骨干皮质含量（SMD：-0.33，-0.56 至-0.10）较低。年龄较大与全身 BMC（SMD：-0.13，-0.21 至-0.04）和 aBMD（SMD：-0.09；-0.17 至-0.01）的 SMD 较大相关，疾病持续时间较长与全身 aBMD（SMD：-0.14；-0.24 至-0.04）的 SMD 较大相关。1 型糖尿病儿童和青少年的 BMC、aBMD 较低，小梁密度和微观结构不足。BMC 和 aBMD 的不足似乎随年龄和疾病持续时间的增加而增加。骨缺陷可能导致骨折风险，需要在糖尿病研究和护理中引起重视。研究注册：PROSPERO（CRD42020200819）。
