ABSTRACT
The aims of this study were to evaluate bone mineral density (BMD) and bone turnover markers in patients with type 1 diabetes and screening-identified evidence of celiac disease, i.e., celiac autoimmunity. We screened 50 consecutive type 1 diabetic patients for IgA antitissue transglutaminase to identify those with celiac autoimmunity. Eight seropositive patients were identified on this screening, and 12 patients matched for gender and age range were selected as a control group from among the type 1 diabetic patients without celiac autoimmunity. Patients and controls underwent dual-energy X-ray absorptiometry (DEXA) for measurement of bone mineral status and had their blood levels of osteocalcin, carboxy-terminal telopeptide of type I collagen (CTX), calcium, and phosphorus determined. BMD was further adjusted for height, weight, and pubertal stage. Radiographic and blood markers of bone mineralization were compared between patients and controls. BMD (Z-score) at the lumbar spine was -1.44 +/- 0.5 SD for patients and 0.04 +/- 0.2 SD for controls (P = 0.02). Bone mineral content was 37.9 +/- 4.5 g for patients and 49.4 +/- 2.6 g for controls (P = 0.049). Adjusted BMD was -0.62 +/- 0.5 SD for patients and 0.81 +/- 0.09 SD for controls (P = 0.04). After adjustment, four patients and none of the controls presented BMD < -1 SD (P = 0.01). Osteocalcin, CTX, calcium, and phosphorus blood levels were not significantly different between patients and controls. Celiac autoimmunity is associated with reduced bone mineralization in type 1 diabetic patients. The pathophysiological mechanisms and clinical relevance of this finding remain to be further investigated.
Subject(s)
Bone Density , Celiac Disease/immunology , Celiac Disease/physiopathology , Diabetes Mellitus, Type 1/immunology , Diabetes Mellitus, Type 1/physiopathology , Absorptiometry, Photon , Adolescent , Case-Control Studies , Female , Humans , Immunoglobulin A/immunology , Male , Statistics, Nonparametric , Transglutaminases/immunologyABSTRACT
UNLABELLED: This cross-sectional study analyzed bone mineral density (BMD) in children and adolescents with type 1 diabetes mellitus (DM1) and its relationship with metabolic control, duration of disease and bone markers. METHODS: Forty-four children and adolescents with DM1 (age 8.8+/-4.4 years, disease duration 6.6+/-3.9 years) and 22 healthy children were assessed for BMD of the lumbar spine (L1-L4) by dual energy X-ray absorptiometry; osteocalcin (OC) and carboxy-terminal telopeptide (CTX) were measured in the study group. RESULTS: The BMD was similar in subjects with (-1.15+/-1.2 S.D.) and without DM1 (-0.85+/-0.88 S.D., p=0.25). After adjustment for weight, height and pubertal development, the BMD was <-2.0 S.D. in only two diabetic patients (4.5%). Bone area (BA) was inversely correlated with the duration of diabetes (p=0.03) and HbA1c (p=0.02). In girls, who presented a worse HbA1c than boys (p<0.01), BMD was inversely correlated with HbA1c (p=0.05). OC and CTX levels were higher in boys (p<0.01) and both inversely correlated with pubertal development (p=0.01), but not with BMD. CONCLUSIONS: Children and adolescents with DM1 have normal bone mass in the lumbar spine. However, longer diabetes duration and poor metabolic control may have a negative impact on bone mass, requiring further investigation through longitudinal studies.
