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J Clin Endocrinol Metab. 2019 Nov 25. pii: dgz221. doi: 10.1210/clinem/dgz221. [Epub ahead of print]

Elevated HbA1c is associated with altered cortical and trabecular microarchitecture in girls with type 1 diabetes.

Author information

1
Endocrine Unit, Massachusetts General Hospital and Harvard Medical School.
2
Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School.
3
Center for Advanced Orthopaedic Studies, Beth Israel Deaconness Medical Center and Harvard Medical School.
4
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School.

Abstract

OBJECTIVE:

To evaluate differences in skeletal microarchitecture between girls with T1D and controls and to assess factors associated with these differences.

DESIGN:

Cross-sectional comparison.

PARTICIPANTS:

: Girls ages 10-16 years, 62 with T1D and 61 controls.

RESULTS:

Areal bone mineral density (BMD) measured by dual-energy x-ray absorptiometry did not differ between girls with and without T1D. At the distal tibia, trabecular BMD was 7.3 ± 2.9% lower in T1D (p=0.013), with fewer plate-like and axially-aligned trabeculae. Cortical porosity was 21.5 ± 10.5% higher while estimated failure load was 4.7 ± 2.2% lower in T1D (p=0.043 and p=0.037 respectively). At the distal radius, BMD and microarchitecture showed similar differences between the groups but did not reach statistical significance. After stratifying by HbA1c, only those girls with T1D and HbA1c >8.5% differed significantly from controls. P1NP, a marker of bone formation, was lower in T1D while CTX and TRAcP5b, markers of bone resorption and osteoclast number respectively, did not differ. IGF-1 Z-score was lower in T1D, and after adjustment for IGF-1 Z-score, associations between T1D status and trabecular microarchitecture were largely attenuated.

CONCLUSIONS:

Skeletal microarchitecture is altered in T1D early in the course of disease and among those with higher average glycemia. Suppressed bone formation and lower circulating IGF-1 likely contribute to this phenotype.

KEYWORDS:

bone density; microarchitecture; pediatrics; type 1 diabetes

PMID:
31761940
DOI:
10.1210/clinem/dgz221

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