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Published online April 24, 2007
Diabetes Care 30:2046-2050, 2007
DOI: 10.2337/dc07-0142
© 2007 by the American Diabetes Association
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Pathophysiology/Complications
Original Article

Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes

Susanne Bechtold, MD, Stefanie Putzker, MD, Walter Bonfig, MD, Oliver Fuchs, MD, Isa Dirlenbach, MD and Hans Peter Schwarz, MD, PHD

From the Division of Pediatric Endocrinology, University Children's Hospital, Munich, Germany

Address correspondence and reprint requests to Susanne Bechtold, MD, University Children's Hospital, Lindwurmstrasse 4 in D-80337, Munich, Germany. E-mail: susanne.bechtold{at}med.uni-muenchen.de

OBJECTIVE—The aim of this study was to establish whether type 1 diabetes has a long-term effect on bone development in children and adolescents.

RESEARCH DESIGN AND METHODS—Bone characteristics and muscle cross-sectional area (CSA) were analyzed cross-sectionally in 41 (19 female and 22 male) patients and were reevaluated after 5.56 ± 0.4 years using peripheral quantitative computed tomography (pQCT). We hypothesize that bone size and muscle mass normalize with age.

RESULTS—At the first evaluation, mean ± SD age was 9.87 ± 2.3 years and disease duration was 4.31 ± 2.9 years. Height was –0.36 ± 1.9 SD, and BMI was 0.39 ± 0.9 SD. Parameters of bone size were low in the whole patient group (corrected for patient's height). At reevaluation, age was 15.44 ± 2.3 years, and patients had a mean height of –0.12 ± 0.8 SD. BMI SD had increased to 0.57 ± 1.1. Total and cortical CSA had normalized. Those patients with an increase in total CSA had a significant younger age at disease manifestation and a younger age at initial pQCT measurement. Bone size was well adapted to muscle mass expressed as the ratio of bone mineral content per muscle mass, and a close correlation was shown between the increase in bone size and in muscle CSA (r = 0.46, P = 0.03).

CONCLUSIONS—Patients with manifestation of type 1 diabetes at an early age had transient impaired bone development. Within the follow-up period, the greatest increase in bone size was found in these patients. In adolescence, all patients had a normal bone size and appropriate adaptation of bone on muscle.

Abbreviations: BMC, bone mineral content • BMD, bone mineral density • CSA, cross-sectional area • CSII, continuous subcutaneous insulin infusion • ICT, intensified conventional therapy • pQCT, peripheral quantitative computed tomography


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