Introduction and Objective: Bone fragility is a recognized complication of T1D, with previous studies reporting conflicting associations with glycemia. We aimed to evaluate BMD and to identify factors associated with BMD in youth with T1D.Methods: This cross-sectional analysis included youth aged 8-17 years with T1D for ≥1 years. Total body less head (TBLH) BMD was assessed using dual-energy X-ray absorptiometry. T1D-related data, anthropometrics, 25-hydroxyvitamin D (25OHD), and weight-bearing activities were assessed for associations with BMD using correlations and unpaired t-tests.Results: Participants (N=124, 49% males) had a mean±SD age of 12.9±2.5 years, T1D duration of 6.0±3.2 years and BMI %ile of 70±23. Mean insulin dose was 0.92±0.3 U/kg/D, 73% CSII-treated, with mean A1c 8.1+1.1%, time-in-range (TIR) 70-180 mg/dL 49±17% and glucose coefficient of variation (%CV) 0.41±0.08. 25OHD was 29.4±8.6 ng/mL, with 9% vit D deficient (25OHD <20). About 1/2 participants (51%) engaged in high-impact weight-bearing activities. Mean BMD z-score was -0.27±1.02, lower than the general pediatric population (p=.003). Factors associated with BMD z-score were BMI %ile (r=0.34, p<.0001), TIR (r=0.23, p=.01) and 25OHD (r=0.22, p=.015). Vit D deficient group had lower BMD z-scores than non-deficient group (∆0.69, p=.03). A1c was negatively correlated with BMD z-score in youth with T1D duration ≤5 years (r=-0.43, p=.001) but not in those with duration >5 years (r=0.06, p=.64). Youth engaging in high-impact activities had higher BMD z-scores than those who did not (∆0.39, p=.03). There were no associations of age, duration, U/kg/D, CSII use or %CV with BMD z-score.Conclusion: Youth with T1D had lower BMD z-scores versus the general population. For youth with T1D, maintaining adequate vit D levels and promoting high-impact activities can benefit BMD. Optimizing A1c and TIR may support bone health; longitudinal studies are needed in youth with T1D for confirmation.
N. Tantivit: None. L.K. Volkening: None. N.E. Renthal: None. C.M. Jacobsen: None. L.M. Laffel: Advisory Panel; Boehringer-Ingelheim, Sanofi, MannKind Corporation, Medtronic, Vertex Pharmaceuticals Incorporated, Tandem Diabetes Care, Inc, Insulet Corporation. Research Support; Dexcom, Inc. Advisory Panel; Sequel Med Tech. Other Relationship; Janssen Pharmaceuticals, Inc. Consultant; Arbor Biotech.
National Institutes of Health (5T32DK007260-47)
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