Phoebe Loxton1, Kruthika Narayan2,3, Craig F Munns2,3, Maria E Craig4,2,3. 1. School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia. 2. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. 3. Children's Hospital Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia. 4. School of Women's and Child's Health, University of New South Wales, Sydney, New South Wales, Australia m.craig@unsw.edu.au.
Abstract
BACKGROUND: There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent. PURPOSE: To perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or quantitative ultrasound (QUS). DATA SOURCES: PubMed, Embase, Scopus, and Web of Science from 1 January 1990 to 31 December 2020, limited to humans, without language restriction. STUDY SELECTION: Inclusion criteria were as follows: cross-sectional or cohort studies that included BMD measured by DXA, pQCT, or QUS in youth (aged <20 years) with type 1 diabetes and matched control subjects. DATA EXTRACTION: We collected data for total body, lumbar spine, and femoral BMD (DXA); tibia, radius, and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference was estimated and meta-regression was performed with age, diabetes duration, and HbA1c as covariates. DATA SYNTHESIS: We identified 1,300 nonduplicate studies; 46 met the inclusion criteria, including 2,617 case and 3,851 control subjects. Mean ± SD age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: total body (WMD -0.04 g/cm2, 95% CI -0.06 to -0.02; P = 0.0006), lumbar spine (-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 g/cm3, -1.55 to -0.27; P = 0.005); phalangeal (-0.32 g/cm3, -0.38 to -0.25; P < 0.00001), and calcaneal (standardized mean difference -0.69 g/cm3, -1.11 to -0.26; P = 0.001). With use of meta-regression, total body BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031; P = 0.002) but not with longer diabetes duration or HbA1c. LIMITATIONS: Meta-analysis was limited by the small number of studies with use of QUS and pQCT and by lack of use of 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.
BACKGROUND: There is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent. PURPOSE: To perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or quantitative ultrasound (QUS). DATA SOURCES: PubMed, Embase, Scopus, and Web of Science from 1 January 1990 to 31 December 2020, limited to humans, without language restriction. STUDY SELECTION: Inclusion criteria were as follows: cross-sectional or cohort studies that included BMD measured by DXA, pQCT, or QUS in youth (aged <20 years) with type 1 diabetes and matched control subjects. DATA EXTRACTION: We collected data for total body, lumbar spine, and femoral BMD (DXA); tibia, radius, and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference was estimated and meta-regression was performed with age, diabetes duration, and HbA1c as covariates. DATA SYNTHESIS: We identified 1,300 nonduplicate studies; 46 met the inclusion criteria, including 2,617 case and 3,851 control subjects. Mean ± SD age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: total body (WMD -0.04 g/cm2, 95% CI -0.06 to -0.02; P = 0.0006), lumbar spine (-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 g/cm3, -1.55 to -0.27; P = 0.005); phalangeal (-0.32 g/cm3, -0.38 to -0.25; P < 0.00001), and calcaneal (standardized mean difference -0.69 g/cm3, -1.11 to -0.26; P = 0.001). With use of meta-regression, total body BMD was associated with older age (coefficient -0.0063, -0.0095 to -0.0031; P = 0.002) but not with longer diabetes duration or HbA1c. LIMITATIONS: Meta-analysis was limited by the small number of studies with use of QUS and pQCT and by lack of use of 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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