Trabecular Bone Score and Bone Turnover Markers Unmask Early Skeletal Fragility in Children and Adolescents With Type 1 Diabetes.

BACKGROUND

Compromised bone health is a recognized consequence of type 1 diabetes mellitus (T1DM), particularly in adults. Studies that comprehensively assess dual-energy x-ray absorptiometry parameters, trabecular bone score (TBS), and bone turnover markers (BTMs) are scarce in children and adolescents with T1DM. Additionally, the relationship between bone health and corneal nerve abnormalities assessed by corneal confocal microscopy, a surrogate of diabetic microangiopathy, remains unexplored.

METHODS

Fifty children/adolescents with T1DM and 46 healthy siblings (aged 11-18 years) were enrolled. Participants underwent assessment for relevant biochemical parameters, including 25-hydroxyvitamin D, and dual-energy x-ray absorptiometry for bone mineral content, bone mineral density (BMD) Z-score, total body less head Z-score, TBS, and BTMs, including osteocalcin, procollagen type 1 N-terminal propeptide, and C-terminal telopeptides. Multivariable general linear models adjusted for age, sex, pubertal status (Tanner stage ≥ II), body mass index Z-score, estimated glomerular filtration rate, and 25-hydroxyvitamin D assessed group differences.

RESULTS

Bone mineral content, BMD Z-score, total body less head Z-score, and height-adjusted BMD were similar between groups, but TBS was significantly lower in T1DM vs controls (adjusted mean 1.37 [95%CI 1.35-1.39] vs 1.41 [95%CI 1.39-1.43]; P = 0.011) even after multivariable adjustment. Likewise, osteocalcin (P < 0.001) and C-terminal telopeptides (P = 0.013) were significantly reduced in T1DM vs controls, while procollagen type 1 N-terminal propeptide showed a nonsignificant downward trend (P = 0.086). Impaired TBS correlated with longer diabetes duration, poorer glycemic control, and corneal confocal microscopy abnormalities on exploratory analysis.

CONCLUSION

Bone microarchitecture and turnover are compromised early in T1DM, preceding detectable changes in conventional BMD. Incorporating TBS and BTMs into bone health assessments may improve early identification of skeletal fragility in this population.