Bone Health May Falter Before Nerves in Adolescence

TOPLINE:

Adolescent girls with type 1 diabetes (T1D) show early deficits in the trabecular bone and decreased cortical porosity in the tibia, which occur before the onset of symptomatic peripheral neuropathy.

METHODOLOGY:

• Both bone fractures and diabetic peripheral neuropathy are increasingly recognized as early complications of T1D; yet, the timing of and relationship between these outcomes are unclear.
• Researchers conducted a single-center cross-sectional study to investigate the association between bone health and diabetic peripheral neuropathy in adolescent girls with and without T1D.
• They included 21 adolescent girls with T1D for ≥ 5 years (mean age, 15.1 years) and an age- and sex-matched control group (n = 12) from the Washington University diabetes registry and pediatric endocrinology clinics.
• High-resolution peripheral quantitative CT and dual-energy radiography absorptiometry (DXA) were used to assess the microarchitecture and mineral density of bones.
• The clinical development of diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI) and a monofilament exam.

TAKEAWAY:

• Adolescent girls with T1D had a 12.6% lower trabecular bone volume fraction at the distal tibia (adjusted P = .017) than did control participants.
• Cortical volumetric bone mineral density in the tibia showed 8.6% increase (adjusted P = .024), and porosity showed a 52.9% decrease (adjusted P = .012) in those with T1D.
• The circulating levels of type I collagen cross-linked C-telopeptide-1 were 36% lower in those with T1D (P = .035), suggesting low bone formation and turnover.
• DXA showed no significant differences in the density of bones.
• All participants showed normal monofilament exam, and two patients (9.5%) with T1D showed evidence of diabetic peripheral neuropathy.

IN PRACTICE:

“Our findings suggest that early identification and management of diabetic bone disease, independent of neuropathy status, is warranted to prevent fracture and related co-morbidities later in life,” the authors wrote.

SOURCE:

The study, led by Ivana Shen and Rachel L. Usala, MD, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, was published online in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS: 

The small sample size may limit the generalizability of the findings. A better average glycemic control in patients with T1D may have limited the severity of diabetes-related pathologies. Although MNSI can detect clinical diabetic peripheral neuropathy , it is unable to detect subclinical neuropathy.

DISCLOSURES:

This study was supported by grants from the National Institutes of Health. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.