Key result
Pediatric type 1 diabetes is linked to reduced bone mineral density versus healthy controls.
Why the study?
There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density, but findings in youth are inconsistent.
Does type 1 diabetes reduce bone mineral density in youth compared to matched controls?
Meta-Analysis (n=6,176)
Does type 1 diabetes reduce bone mineral density in youth compared to matched controls?
Youth with type 1 diabetes have significantly lower bone mineral density across multiple modalities compared to matched controls, suggesting a need for routine BMD assessment.
Answers are grounded in this paper and cite their sources.
Supports BMD assessment in youth with type 1 diabetes; confirms lower density as a consistent finding.
Background There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD), however findings in youth are inconsistent. Purpose Systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: dual energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and/or quantitative ultrasound (QUS). Data Sources PubMed, Embase, Scopus and Web of Science from 01/01/1990 to 31/12/2020, limited to humans, without language restriction. Study Selection Inclusion criteria: cross sectional or cohort studies that included BMD measured either by DXA, pQCT and/or QUS in youth (age <20 years) with type 1 diabetes and matched controls. Data extraction Total body (TB), lumbar spine (LS) and femoral BMD (DXA); tibia, radius and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference (SMD) were estimated and meta-regression was performed using age, diabetes duration and HbA1c as covariates. Data Synthesis We identified 1300 non-duplicate studies; 46 met the inclusion criteria, including 2617 cases and 3851 controls. Mean age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: TB (WMD -0.04 g/cm2, 95% CI -0.06 to -0.02, P=0.0006); LS (-0.02 g/cm2, -0.03 to -0.0, P = 0.01); femur (-0.04 g/cm2, -0.05 to -0.03, P<0.00001); tibial trabecular (-11.32 g/cm3,-17.33 to -5.30, P=0.0002), radial trabecular (-0.91, -1.55 to -0.27, P=0.005); phalangeal (-0.32, -0.38 to -0.25, P<0.00001) and calcaneal (SMD -0.69, -1.11 to -0.26, P=0.001). Using meta-regression TB BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031, P=0.002), but not longer diabetes duration or HbA1c. Limitations Meta-analysis was limited by the small number of studies using QUS and pQCT and lack of use BMD z-scores in all studies. Conclusions Bone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.
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Loxton et al. (2021) conducted a meta-analysis in Type 1 Diabetes (n=6,176). Type 1 Diabetes vs. Healthy controls was evaluated on Bone mineral density (BMD). Type 1 diabetes in children and adolescents was evaluated for its association with bone mineral density compared to healthy controls across 46 studies, though specific quantitative pooled results are not provided in the supplementary text.
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