Home Evaluation of bone mineral density in children with type 1 diabetes mellitus
Article
Licensed
Unlicensed Requires Authentication

Evaluation of bone mineral density in children with type 1 diabetes mellitus

  • Asan Onder EMAIL logo , Semra Cetinkaya , Ozgul Tunc and Zehra Aycan
Published/Copyright: October 11, 2013
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 26 Issue 11-12

Abstract

Background: Factors such as vascular/neurological mechanisms, poor glycemic control, abnormalities in vitamin D/calcium, secondary hyperparathyroidism, and hypercalciuria have been blamed for the unfavorable effects of type 1 diabetes mellitus (type 1 DM) on bone health. In this present study, we aimed to evaluate the frequency of low bone mineral density (BMD) in children with type 1 DM.

Method: Among 100 type 1 DM patients, a 25-hydroxy vitamin D level of <10 ng/mL was accepted as vitamin D deficiency and the level of 10–20 ng/dL was accepted as vitamin D insufficiency. BMD was measured, and Z-scores were evaluated according to adjusted Turkish standards. Participants with a Z-score of ≤–2 were defined as having low BMD; BMD between –2 and –1 were defined as being in the low range of normality; and values ≥–1 were accepted as normal.

Results: The vitamin D deficiency and insufficiency ratios were 28% and 43%, respectively. Low BMD and BMD in the low range of normality were diagnosed in 10% and 25% of patients, respectively. There was no difference in vitamin D, parathormone, and metabolic control levels between three groups: with normal BMD, low BMD, and BMD in the low range of normality. BMD Z-scores were not different between the pubertal and prepubertal groups.

Conclusion: Detailed evaluation should be performed for BMD in the follow-up of DM to prevent complications by decreasing related risks.

Keywords: child; diabetes mellitus; osteopenia; osteoporosis; vitamin D
Corresponding author: Dr. Asan Onder, Dr. Sami Ulus Kadın-Dogum, Cocuk Saglıgı ve Hastalıkları Egitim ve Arastırma Hastanesi, Pediyatrik Endokrinoloji Klinigi, Ankara 06100, Turkey, Phone: +90 312 305 65 08, Fax: +90 317 03 53, E-mail:

References

1. Abd El Dayem SM, El-Shehaby AM, Abd El Gafar A, Fawzy A, Salama H. Bone density, body composition, and markers of bone remodeling in type 1 diabetic patients. Scand J Clin Lab Invest 2011;71:387–93.10.3109/00365513.2011.573574Search in Google Scholar

2. Hamann C, Kirschner S, Günther KP, Hofbauer LC. Bone, sweet bone osteoporotic fractures in diabetes mellitus. Nat Rev Endocrinol 2012;8:297–305.10.1038/nrendo.2011.233Search in Google Scholar

3. Blakytny R, Spraul M, Jude EB. Review. The diabetic bone: a cellular and molecular perspective. Int J Low Extrem Wounds 2011;10:16–32.10.1177/1534734611400256Search in Google Scholar

4. Pedrazzoni M, Ciotti G, Pioli G, Girasole G, Davoli L, et al. Osteocalcin levels in diabetic subjects. Calcif Tissue Int 1989;45:331–6.10.1007/BF02556002Search in Google Scholar

5. Olmos JM, Perez-Castrillon JL, Garcia MT, Garrido JC, Amado JA, et al. Bone densitometry and biochemical bone remodeling markers in type 1 diabetes mellitus. Bone Miner 1994;26:1–8.10.1016/S0169-6009(08)80157-2Search in Google Scholar

6. Selby PL, Shearing PA, Marshall SM. Hydroxyproline excretion is increased in diabetes mellitus and related to the presence of microalbuminuria. Diabetes Med 1995;12:240–3.10.1111/j.1464-5491.1995.tb00465.xSearch in Google Scholar

7. Ward DT, Yau SK, Mee AP, Mawer EB, Miller CA, et al. Funcitonal, molecular and biochemical characterization of streptozotocin induced diabetes. J Am Soc Nephrol 2001;12:779–90.10.1681/ASN.V124779Search in Google Scholar

8. Bjorgaas M, Haug E, Johnsen HJ. The urinary excretion of deoxypyridinium cross-links is higher in diabetic than in nondiabetic adolescents. Calcif Tissue Int 1999;65:121–4.10.1007/s002239900668Search in Google Scholar

9. Inzerillo AM, Epstein S. Osteoporosis and diabetes mellitus. Rev Endocr Metab Disord 2004;5:261–8.10.1023/B:REMD.0000032415.83124.20Search in Google Scholar

10. Vashishth D, Gibson GJ, Khoury JI, Schaffler MB, Kimura J, et al. Influence of non-enzymatic glycation on biomechanical properties of cortical bone. Bone 2001;28:195–201.10.1016/S8756-3282(00)00434-8Search in Google Scholar

11. Armas LA, Akhter MP, Drincic A, Recker RR. Trabecular bone histomorphometry in humans with Type 1 diabetes mellitus. Bone 2012;50:91–6.10.1016/j.bone.2011.09.055Search in Google Scholar

12. Dubey A, Aharonoff GB, Zuckerman JD, Koval KJ. The effects of diabetes on outcome after hip fracture. Bull Hosp Jt Dis 2000;59:94–8.Search in Google Scholar

13. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, et al.; Study of Ostoporotic Fractures Research Group. Older woman with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001;86:32–8.10.1210/jcem.86.1.7139Search in Google Scholar

14. Forsen L, Meyer HE, Midthjell K, Edna TH. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetoloogia 1999;42:920–5.10.1007/s001250051248Search in Google Scholar

15. Yaturu S. Diabetes and skeletal health. J Diabetes 2009;1:246–54.10.1111/j.1753-0407.2009.00049.xSearch in Google Scholar

16. Saggese G, Baroncelli GI, Bertelloni S. Puberty and bone development. Best Pract Res Clin Endocrinol Metab 2002; 16:53–64.10.1053/beem.2001.0180Search in Google Scholar

17. Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr 1987;110:481–7.10.1016/S0022-3476(87)80522-XSearch in Google Scholar

18. Goksen D, Darcan S, Coker M, Kose T. Bone mineral density of healthy Turkish children and adolescents. J Clin Densitom 2006;9:84–90.10.1016/j.jocd.2005.08.001Search in Google Scholar PubMed

19. Shaw NJ. Management of osteoporosis in children. Eur J Endocrinol 2008;159:33–9.10.1530/EJE-08-0282Search in Google Scholar PubMed

20. Bowden SA, Robinson RF, Carr R, Mahan JD. Prevalence of vitamin D deficiency and insufficiency in children with osteopenia or osteoporosis referred to a pediatric metabolic bone clinic. Pediatrics 2008;121:1585–90.10.1542/peds.2007-2111Search in Google Scholar PubMed

21. Schwartz AV. Diabetes mellitus: does it affect bone? Calcif Tissue Int 2003;73:515–9.10.1007/s00223-003-0023-7Search in Google Scholar PubMed

22. de Paula FJ, Horowitz MC, Rosen CJ. Novel insights into the relationship between diabetes and osteoporosis. Diabetes Metab Res Rev 2010;26:622–30.10.1002/dmrr.1135Search in Google Scholar PubMed PubMed Central

23. Kurra S, Siris E. Diabetes and bone health: the relationship between diabetes and osteoporosis-associated fractures. Diabetes Metab Res Rev 2011;27:430–5.10.1002/dmrr.1197Search in Google Scholar PubMed

24. Leidig-Bruckner G, Ziegler R. Diabetes mellitus a risk for osteoporosis? Exp Clin Endocrinol Diabetes 2001;109: 493–514.10.1055/s-2001-18605Search in Google Scholar PubMed

25. Kemink SA, Hermus AR, Swinkels LM, Lutterman JA, Smals AG. Osteopenia in insulin-dependent diabetes mellitus; prevalence and aspects of pathophysiology. J Endocrinol Invest 2000;23:295–303.10.1007/BF03343726Search in Google Scholar PubMed

26. Hamed EA, Faddan NH, Elhafeez HA, Sayed D. Parathormone 25(OH)-vitamin D axis and bone status in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2011;12:536–46.10.1111/j.1399-5448.2010.00739.xSearch in Google Scholar PubMed

27. Neumann T, Sämann A, Lodes S, Kästner B, Franke S, et al. Glycaemic control is positively associated with prevalent fractures but not with bone mineral density in patients with Type 1 diabetes. Diabet Med 2011;28:872–5.10.1111/j.1464-5491.2011.03286.xSearch in Google Scholar PubMed

28. Karagüzel G, Akçurin S, Ozdem S, Boz A, Bircan I. Bone mineral density and alterations of bone metabolism in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2006;19:805–14.10.1515/JPEM.2006.19.6.805Search in Google Scholar

Received: 2012-11-20
Accepted: 2013-3-5
Published Online: 2013-10-11
Published in Print: 2013-11-01

©2013 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Review article
  4. Application of imaging modalities for evaluating neuroblastoma
  5. Images in pediatric endocrinology
  6. Lingual thyroid
  7. Original articles
  8. A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism
  9. Fasting glucagon-like peptide-1 in patients with overt hyperthyroidism and euthyroid congenital hypothyroidism
  10. Perinatal complications and higher risks of offspring thyroid dysfunction in early childhood of Graves’ disease mothers with euthyroidism
  11. Clinical characteristics and management of cranial diabetes insipidus in infants
  12. Desmopressin administration in children with central diabetes insipidus: a retrospective review
  13. An electronic surveillance system for monitoring the hospital presentation of nutritional vitamin D deficiency in children in Scotland
  14. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted
  15. Vitamin D status is associated with early markers of cardiovascular disease in prepubertal children
  16. Evaluation of bone mineral density in children with type 1 diabetes mellitus
  17. Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days
  18. Relationship of body mass index and GAD65 antibody status on β-cell secretion at diabetes onset in African-American children
  19. Serum dipeptidyl peptidase 4 activity in children with type 1 diabetes mellitus
  20. Concomitant autoantibodies in newly diagnosed diabetic children with transient celiac serology or proven celiac disease
  21. Assessment of user-friendliness of the Norditropin FlexPro for pediatric patients treated with recombinant human growth hormone: results of an open-label user survey
  22. Cognitive impairment and gray/white matter volume abnormalities in pediatric patients with Turner syndrome presenting with various karyotypes
  23. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
  24. Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system
  25. Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents
  26. Could GSD type I expand the spectrum of disorders with elevated plasma chitotriosidase activity?
  27. Patient reports
  28. Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
  29. Successful subcutaneous glucagon use for persistent hypoglycaemia in congenital hyperinsulinism
  30. A novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
  31. Diagnosis of septo-optic dysplasia in a neonate with hypernatremia, hypoglycemia, and persistent hypothermia
  32. Speech and language delay in two children: an unusual presentation of hyperthyroidism
  33. Lissencephaly presenting with congenital hypothyroidism
  34. PHEX gene mutation in a Chinese family with six cases of X-linked hypophosphatemic rickets
  35. Primary hyperparathyroidism as an extremely rare cause of secondary myelofibrosis in childhood
  36. A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands
  37. A case of SCNN1A splicing mutation presenting as mild systemic pseudohypoaldosteronism type 1
  38. Central precocious puberty in a girl with Prader-Willi syndrome
  39. Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia
  40. Short communication
  41. No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children
  42. Letter to the Editor
  43. Reliability and validity of homeostasis model assessment for insulin resistance and β-cell dysfunction in critically ill children with hyperglycemia
https://doi.org/10.1515/jpem-2012-0369
Keywords for this article
child; diabetes mellitus; osteopenia; osteoporosis; vitamin D

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Review article
  4. Application of imaging modalities for evaluating neuroblastoma
  5. Images in pediatric endocrinology
  6. Lingual thyroid
  7. Original articles
  8. A levothyroxine dose recommendation for the treatment of children and adolescents with autoimmune thyroiditis induced hypothyroidism
  9. Fasting glucagon-like peptide-1 in patients with overt hyperthyroidism and euthyroid congenital hypothyroidism
  10. Perinatal complications and higher risks of offspring thyroid dysfunction in early childhood of Graves’ disease mothers with euthyroidism
  11. Clinical characteristics and management of cranial diabetes insipidus in infants
  12. Desmopressin administration in children with central diabetes insipidus: a retrospective review
  13. An electronic surveillance system for monitoring the hospital presentation of nutritional vitamin D deficiency in children in Scotland
  14. Frequency and severity of ketoacidosis at onset of autoimmune type 1 diabetes over the past decade in children referred to a tertiary paediatric care centre: potential impact of a national programme highlighted
  15. Vitamin D status is associated with early markers of cardiovascular disease in prepubertal children
  16. Evaluation of bone mineral density in children with type 1 diabetes mellitus
  17. Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days
  18. Relationship of body mass index and GAD65 antibody status on β-cell secretion at diabetes onset in African-American children
  19. Serum dipeptidyl peptidase 4 activity in children with type 1 diabetes mellitus
  20. Concomitant autoantibodies in newly diagnosed diabetic children with transient celiac serology or proven celiac disease
  21. Assessment of user-friendliness of the Norditropin FlexPro for pediatric patients treated with recombinant human growth hormone: results of an open-label user survey
  22. Cognitive impairment and gray/white matter volume abnormalities in pediatric patients with Turner syndrome presenting with various karyotypes
  23. Prevalence of metabolic syndrome among urban Indian adolescents and its relation with insulin resistance (HOMA-IR)
  24. Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system
  25. Evaluation of serum neopterin levels and its relationship with adipokines in pediatric obesity-related nonalcoholic fatty liver disease and healthy adolescents
  26. Could GSD type I expand the spectrum of disorders with elevated plasma chitotriosidase activity?
  27. Patient reports
  28. Treatment of hyperinsulinemic hypoglycemia because of diffuse nesidioblastosis with nifedipine after surgical therapies in a newborn
  29. Successful subcutaneous glucagon use for persistent hypoglycaemia in congenital hyperinsulinism
  30. A novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
  31. Diagnosis of septo-optic dysplasia in a neonate with hypernatremia, hypoglycemia, and persistent hypothermia
  32. Speech and language delay in two children: an unusual presentation of hyperthyroidism
  33. Lissencephaly presenting with congenital hypothyroidism
  34. PHEX gene mutation in a Chinese family with six cases of X-linked hypophosphatemic rickets
  35. Primary hyperparathyroidism as an extremely rare cause of secondary myelofibrosis in childhood
  36. A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands
  37. A case of SCNN1A splicing mutation presenting as mild systemic pseudohypoaldosteronism type 1
  38. Central precocious puberty in a girl with Prader-Willi syndrome
  39. Type 1 diabetes mellitus in a patient with homozygous sickle cell anemia
  40. Short communication
  41. No impact of obesity susceptibility loci on weight regain after a lifestyle intervention in overweight children
  42. Letter to the Editor
  43. Reliability and validity of homeostasis model assessment for insulin resistance and β-cell dysfunction in critically ill children with hyperglycemia
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 25.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2012-0369/html
Scroll to top button