Bone density, body composition, and markers of bone remodeling in type 1 diabetic patients

Abstract Objective. To assess bone mineral density (BMD), body composition by dual X-ray absorptiometry (DXA), and various biochemical markers of bone growth and resorption in a group of children with type 1 diabetes mellitus (T1DM). Patients and methods. The study included 47 patients with T1DM and 30 age- and sex-matched controls. Anthropometric measurements, biochemical markers for bone formation, bone resorption and DXA were done for all patients and controls. Results. Of our diabetes patients, seven (16.7 %), three (7.3 %), and 17 (41.5%) met diagnostic criteria for osteopenia at the right femur, lumbar spine and total body, respectively. On the other hand, osteoporosis as defined by the WHO criteria was diagnosed in 21 patients (51.2%) at the total body by DXA. Lean body mass and lean fat ratio were lower, while, total fat mass, abdominal fat%, soft tissue fat mass%, and fat/lean ratio were higher in diabetics compared to controls. Also, our patients showed lower serum osteocalcin, osteoprotegerin, procollagen type 1, and higher urinary deoxypyridinoline. Pubertal (diabetics and controls) have higher BMD and BMC than prepubertal. Conclusion. Diabetic patients had a low BMD after adjustment (Z score), low bone formation and high bone resorption markers. Diabetes control and increase in BMI leads to a decrease in the incidence of low bone mineral density. Diabetes causes an increase in body fat especially abdominal fat which leads to an increase in insulin resistance and decrease in lean mass.

[1]  E. Rahme,et al.  Osteoporosis among patients with type 1 and type 2 diabetes. , 2008, Diabetes & metabolism.

[2]  S. Weisnagel,et al.  Body Composition Indices in Women With Well-Controlled Type 1 Diabetes , 2008, Diabetes Care.

[3]  E. Vicente,et al.  Bone metabolism is linked to disease duration and metabolic control in type 1 diabetes mellitus. , 2007, Diabetes research and clinical practice.

[4]  A. Żebrowska,et al.  Clinical research Osteopenia and osteoporosis in patients with dermatitis herpetiformis. Effect of gluten-free diet , 2007 .

[5]  J. Jamart,et al.  Bone density and markers of bone remodeling in type 1 male diabetic patients. , 2006, Diabetes & metabolism.

[6]  G. Sebag,et al.  Lower bone mineral content in children with type 1 diabetes mellitus is linked to female sex, low insulin-like growth factor type I levels, and high insulin requirement. , 2006, The Journal of clinical endocrinology and metabolism.

[7]  K. Raile,et al.  Early Manifestation of Type 1 Diabetes in Children Is a Risk Factor for Changed Bone Geometry: Data Using Peripheral Quantitative Computed Tomography , 2006, Pediatrics.

[8]  A. Krikorian,et al.  Standards of medical care in diabetes--2006. , 2006, Diabetes care.

[9]  D. Balzi,et al.  Is insulin an anabolic agent in bone? Dissecting the diabetic bone for clues. , 2005, American journal of physiology. Endocrinology and metabolism.

[10]  J. Eisman,et al.  Contribution of Hip Strength Indices to Hip Fracture Risk in Elderly Men and Women , 2005, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[11]  C. Kelly,et al.  Influence of diabetes on peripheral bone mineral density in men: a controlled study , 2005, Acta Diabetologica.

[12]  Y. Seino,et al.  Osteoclastic function is accelerated in male patients with type 2 diabetes mellitus: the preventive role of osteoclastogenesis inhibitory factor/osteoprotegerin (OCIF/OPG) on the decrease of bone mineral density. , 2005, Diabetes research and clinical practice.

[13]  L. Moyer-Mileur,et al.  Bone mineral acquisition in adolescents with type 1 diabetes. , 2004, The Journal of pediatrics.

[14]  A. Salvatoni,et al.  Bone mineral density in diabetic children and adolescents: a follow-up study. , 2004, Bone.

[15]  S. Etcheverry,et al.  Advanced glycation endproducts interefere with integrin-mediated osteoblastic attachment to a type-I collagen matrix. , 2004, The international journal of biochemistry & cell biology.

[16]  C. Berne,et al.  Body composition in adolescent girls with Type 1 diabetes , 2003, Diabetic medicine : a journal of the British Diabetic Association.

[17]  K. Faulkner.  Improving femoral bone density measurements. , 2003, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[18]  J. Dmochowski,et al.  Does low bone mineral density start in post-teenage years in women with type 1 diabetes? , 2003, Diabetes care.

[19]  A. Franzese,et al.  The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus , 2002, Hormone Research in Paediatrics.

[20]  P. Delmas,et al.  Osteoprotegerin serum levels in men: correlation with age, estrogen, and testosterone status. , 2001, The Journal of clinical endocrinology and metabolism.

[21]  L. Bachrach.  Acquisition of optimal bone mass in childhood and adolescence , 2001, Trends in Endocrinology & Metabolism.

[22]  U. Kabadi,et al.  Hyperinsulinemia and central adiposity: influence of chronic insulin therapy in type 1 diabetes. , 2000, Diabetes Care.

[23]  Wd Evans,et al.  Measured and predicted bone mineral content in healthy boys and girls aged 6–18 years: adjustment for body size and puberty , 1998, Acta paediatrica.

[24]  C. Hassager,et al.  Body composition and fat distribution measured by dual-energy x-ray absorptiometry in premenopausal and postmenopausal insulin-dependent and non-insulin-dependent diabetes mellitus patients. , 1998, Metabolism: clinical and experimental.

[25]  S. Mora,et al.  Bone Modeling Indexes at Onset and During the First Year of Follow-Up in Insulin-Dependent Diabetic Children , 1997, Calcified Tissue International.

[26]  Manuela Muñoz-Torres,et al.  Bone mineral density measured by dual X-ray absorptiometry in Spanish patients with insulin-dependent diabetes mellitus , 1996, Calcified Tissue International.

[27]  N. Ghannam,et al.  Book review: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. , 1994, Annals of Saudi medicine.

[28]  J. Compston,et al.  Whole body composition and regional bone mass in women with insulin‐dependent diabetes mellitus , 1994, Clinical endocrinology.

[29]  C. Christiansen,et al.  Development of bone mineral loss in insulin‐treated diabetes: a 1 1/2 years follow‐up study in sixty patients , 1981, European journal of clinical investigation.

[30]  J. Tanner,et al.  A note on the bone age at which patients with true isolated growth hormone deficiency enter puberty. , 1975, The Journal of clinical endocrinology and metabolism.

[31]  J M Tanner,et al.  Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. , 1966, Archives of disease in childhood.

[32]  Robert P. Pikul,et al.  Bone mineral density and hip structural analysis in type 1 diabetic men. , 2007, European journal of endocrinology.

[33]  A. Żebrowska,et al.  Osteopenia and osteoporosis in patients with dermatitis herpetiformis . Effect of gluten-free diet , 2007 .

[34]  M. Paoli,et al.  Decreased Bone Mineral Density and Bone Formation Markers Shortly After Diagnosis of Clinical Type 1 Diabetes Mellitus , 2001, Journal of pediatric endocrinology & metabolism : JPEM.

[35]  K. Thrailkill.  Insulin-like growth factor-I in diabetes mellitus: its physiology, metabolic effects, and potential clinical utility. , 2000, Diabetes technology & therapeutics.

[36]  I. Morimoto,et al.  [Insulin-like growth factor I in diabetes]. , 1998, Nihon rinsho. Japanese journal of clinical medicine.

[37]  C. Binder,et al.  Creatinine height index and lean body mass in adult patients with insulin-dependent diabetes mellitus followed for 7 years from onset. , 1994, JPEN. Journal of parenteral and enteral nutrition.