Progressive deterioration of bone density and geometry in children and adolescents with type 1 diabetes: A 4-year DXA and pQCT based study.
TL;DR
Sex, pubertal status, glycaemic control, disease duration, and dyslipidemia were significant predictors of skeletal outcomes in children and adolescents with T1DM and discordance between bone density and geometry suggests that alterations in skeletal structure may not be fully reflected by areal bone density measurements alone.
Abstract
Background
We aimed to evaluate longitudinal changes in bone health over 4 years, examine differences based on diabetes duration, and identify predictors of skeletal outcomes in children and adolescents with T1DM.
Methods
A single-centre, retrospective, longitudinal observational study was conducted at tertiary care centre in Western Maharashtra, India (December 2015-December 2022). Longitudinal data of children and adolescents from Sweetlings cohort on anthropometry, body composition, biochemical parameters, and bone health (DXA, pQCT) were extracted.
Results
A total of 200 participants (mean age:10.6 ± 3.9 years; diabetes duration:3.2 ± 3.2 years) were followed for 4 years. Glycaemic control worsened over time, with increased insulin requirement and HbA1c, along with reduced insulin sensitivity. Decline in TBLH aBMD Z-scores (-1.4 ± 1.1 to -1.7 ± 1.2) was observed. Significant reductions in trabecular vBMD (167.7 ± 35.6 to 150.2 ± 39.8 mg/cm3), trabecular density-for-age Z-scores (-0.9 ± 1.5 to -1.7 ± 1.2), and total density-for-age Z-scores (-0.5 ± 1.5 to -1.0 ± 1.0), along with decline in cortical thickness, despite increase in cortical vBMD were reported. Participants with diabetes duration ≥5 years had lower insulin sensitivity, lean body mass, and bone parameters at baseline and follow-up, and experienced greater declines in trabecular and total volumetric BMD. Sex, pubertal status, glycaemic control, disease duration, and dyslipidemia were significant predictors of skeletal outcomes.
Conclusion
Children and adolescents with T1DM demonstrate progressive deterioration in bone health over time, particularly those with longer disease duration and adverse metabolic profiles. The discordance between bone density and geometry suggests that alterations in skeletal structure may not be fully reflected by areal bone density measurements alone. Early identification of high-risk individuals and longitudinal monitoring may help preserve bone health.