February 03, 2020
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Bone turnover markers decreased in children with type 1 diabetes

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Jens Otto Broby Madsen

A cohort of children and adolescents with type 1 diabetes had markers of bone formation and bone resorption that were significantly decreased compared with children without diabetes, independent of diabetes duration and Tanner stages, according to findings published in Pediatric Diabetes.

“The take-home message from the study is that bone turnover is altered in children and adolescents with type 1 diabetes, and metabolic outcomes in the form of HbA1c are associated with markers of bone resorption,” Jens Otto Broby Madsen, MD, PhD, of the department of pediatrics and adolescent medicine at Herlev Hospital, Denmark, told Healio. “This association is a potential explanation of the common finding of decreased bone mineral density among adults with type 1 diabetes and has also been hypothesized as the cause of altered microarchitecture found in recent studies of children and adolescents.”

Madsen and colleagues analyzed data from 173 children and adolescents with type 1 diabetes (47% girls; median age, 14 years; median diabetes duration, 3.5 years) recruited from the diabetes outpatient clinic at Herlev University Hospital. Children underwent BMD measurements via DXA and provided blood samples for measurements of selected bone turnovers markers including osteocalcin, procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX). Researchers used new data from 1,410 samples from healthy Danish school-aged children as reference. Children were stratified by diabetes duration (1-2 years, 2-3 years, 3-5 years, 5-7 years, 7-9 years and more than 9 years), and bone turnover markers were compared between duration groups using one-way analysis of variance models. Researchers used multiple regression analyses to investigate the relationship between each bone turnover marker and HbA1c, diabetes duration and BMD.

Researchers found that mean z scores for osteocalcin and P1NP were –0.68 and –0.33, respectively, both lower than the reference population (P < .001). Likewise, CTX was decreased compared with the reference population, with a mean z score of –0.43 (P < .001). There were no associations between bone turnover markers and diabetes duration.

Fracture hip x-ray 2019.  
A cohort of children and adolescents with type 1 diabetes had markers of bone formation and bone resorption that were significantly decreased compared with children without diabetes, independent of diabetes duration and Tanner stages.
Source: Adobe Stock

Researchers also found that BMD z score was comparable with the reference population and was not associated with individual bone turnover markers. However, CTX z score was negatively associated with HbA1c (P = .007) independent of changes in insulin exposure.

“Decreased bone turnover markers might be the first warning of a negative effect of type 1 diabetes on bone health,” Madsen said. “Bone turnover markers might be a way of screening for early changes, long before changes can be seen by DXA scans.” – by Regina Schaffer

For more information:

Jens Otto Broby Madsen, MD, PhD, can be reached at Herlev Hospital, Borgmester Ib Juuls Vej 25D, Herlev, Denmark; email: jens.otto.broby.madsen@regionh.dk.

Disclosures: The authors report no relevant financial disclosures.