Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis
There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD), however findings in youth are inconsistent.
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).
PubMed, Embase, Scopus and Web of Science from 01/01/1990 to 31/12/2020, limited to humans, without language restriction.
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.
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.
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.
Meta-analysis was limited by the small number of studies using QUS and pQCT and lack of use BMD z-scores in all studies.
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.