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      Cambios en la masa ósea en una población infantil con diabetes mellitus tipo 1. Estudio longitudinal Translated title: Changes in bone mass in a child population with type 1 diabetes mellitus. Longitudinal study

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          Abstract

          Resumen Objetivo: Evaluar, a lo largo de un seguimiento de 79,2 meses, el comportamiento de la densidad mineral ósea (DMO) determinada mediante Densitometría Axial Computarizada (DXA), la densidad mineral ósea volumétrica (DMOvol) y su relación con los datos antropométricos, junto con los parámetros relativos al metabolismo óseo (calcio, fósforo, fosfatasa alcalina, parathormona (PTH) y vitamina D (25-OH-D3)) en una población infantil con Diabetes Mellitus Tipo 1 (DM1) sin complicaciones microvasculares y un grupo control de referencia de similares características. Pacientes y métodos: Se observó que, al inicio, la masa ósea fue similar en los diabéticos y controles. Después del seguimiento, la DMO de los niños diabéticos era muy inferior a la esperada en población infantil no diabética. El peso, la altura y el Índice de Masa Corporal (IMC) siguieron el mismo patrón que la DMO. Los valores de calcio, fósforo, fosfatasa alcalina, PTH y vitamina D, aunque en rango de normalidad, fueron más bajos que en los controles. La fosfatasa alcalina no se incrementó en el periodo puberal. Resultados: Aplicando los umbrales específicos de la edad, 2% de las mujeres calificaron para tratamiento y 73,7% para evaluación de la densidad mineral ósea. Según la edad, las mujeres elegibles para tratamiento fluctuaron entre 0,7 a 3,8% y las elegibles para evaluación de la densidad mineral ósea entre 58,3 al 80,5%. Con el umbral fijo, 31% de las mujeres calificaron para tratamiento y 76,3% para evaluación de la densidad mineral ósea. Dependiendo de la edad, las mujeres potencialmente elegibles para tratamiento fluctuaron de 3,8 a 76,5%, y las elegibles para evaluación de la densidad mineral ósea entre 65,2 al 85,4%. Conclusiones: El presente estudio demuestra que los niños y adolescentes con un diagnóstico reciente de DM1 tienen una DMO normal. Sin embargo, con el paso del tiempo, y sobre todo durante la adolescencia, muestran una menor ganancia de masa ósea y alteraciones en los parámetros de recambio óseo.

          Translated abstract

          Summary Objetive: To evaluate, over a 79.2-month follow-up period, the behavior of bone mineral density (BMD) determined by Computerized Axial Densitometry (DXA), volumetric bone mineral density (BMDvol) and its relationship with anthropometric data, together with the parameters related to bone metabolism (calcium, phosphorus, alkaline phosphatase, parathormone (PTH) and vitamin D (25-OH-D3)) in a child population with Type 1 Diabetes Mellitus (DM1) without microvascular complications and a control group of reference with similar characteristics. Patients and methods: Transversal study in which 2,283 women aged 60 to 94 years were selected. We calculated the risk of major osteoporotic and femoral neck fractures with the Ecuadorian FRAX model (version 4.1), and calculated the proportion of individuals eligible for treatment and bone mineral density assessment applying age-specific thresholds of 60 to 94 years and a fixed threshold from 75 years. Results: It was observed that, at baseline, bone mass was similar in diabetics and controls. After follow-up, the BMD of the diabetic children was much lower than that expected in the non-diabetic child population. Weight, height, and Body Mass Index (BMI) followed the same pattern as BMD. The values of calcium, phosphorus, alkaline phosphatase, PTH and vitamin D, although within the normal range, were lower than in the controls. Alkaline phosphatase did not increase in the pubertal period. Conclusions: The present study demonstrates that children and adolescents with a recent diagnosis of DM1 have a normal BMD. However, over time, and especially during adolescence, they show less bone mass gain and changes in bone turnover parameters.

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          Osteopenia in insulin-dependent diabetes mellitus; prevalence and aspects of pathophysiology.

          The objective was to evaluate the prevalence and severity of osteopenia in patients with uncomplicated insulin-dependent diabetes mellitus (IDDM) and to obtain more information on the pathophysiology of diabetic osteopenia. In 35 patients with uncomplicated IDDM (21 men and 14 women; age 37.6+/-9.9 yr; duration of disease 8.5+/-3.5 years) bone mineral density was measured by dual energy X-ray absorptiometry (DEXA). In addition, markers of bone formation [plasma insulin-like growth factor I (IGF-I), serum alkaline phosphatase (ALP), serum bone alkaline phosphatase (BAP) and serum osteocalcin] and bone resorption [urinary excretion of calcium and of the cross-linked N-telopeptide of type 1 collagen, both corrected for the excretion of creatinine] were measured in the diabetic patients and in 33 healthy controls, matched for sex, age, height, weight and body mass index (BMI). In 67% of the diabetic men and 57% of the diabetic women osteopenia of the femoral neck and/or the lumbar spine (T-value < or = -1 SD) was present. Fourteen percent of the male patients, but none of the female patients, met the criteria for osteoporosis (T-value < or = -2.5 SD). In the whole group of diabetic patients the mean plasma IGF-I level tended to be lower (p<0.10) as compared to that in the controls. In the diabetic patients with femoral neck osteopenia, the mean plasma IGF-I level was significantly lower (p<0.05) than in those without osteopenia at this site. There were no differences in the mean serum ALP, BAP and osteocalcin levels between the diabetic patients and the controls, nor between the diabetic patients with and without femoral neck osteopenia. Considering only the male diabetic patients, significantly lower mean plasma IGF-I (-26%), serum ALP (-24%) and serum osteocalcin (-38%) levels were present in the patients with femoral neck osteopenia than in those without osteopenia at this site, suggesting lowered bone formation. The bone resorption markers were similar in all (sub)groups of diabetic patients and not different between diabetic patients and controls. Bone mineral density (BMD) did not correlate with plasma levels of glycosylated hemoglobin (HbA1c). BMD values were not related to any of the bone resorption or formation markers, except for plasma IGF-I both in the femoral neck (r=+0.38, p=0.026) and the lumbar spine (r=+0.34, p=0.043). Our data demonstrate that at least in male patients with IDDM, osteopenia is the consequence of a lowered bone formation with a predominance of bone resorption over formation.
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            Comparison of different models for interpreting bone mineral density measurements using DXA and MRI technology.

            Bone mineral density measurements using dual X-ray absorptiometry (DXA) are commonly expressed as areal density (g/cm2). However, areal BMD (BMDareal) is dependent on bone size and this can lead to erroneous interpretations of BMD values. We have previously presented a simple method for calculating apparent volumetric bone mineral density (BMDvol) using ancillary DXA-derived data. In the present study we tested the validity of our model using in vivo volumetric data obtained from magnetic resonance imaging (MRI) of lumbar vertebrae. BMDareal and BMDvol of L3 were measured from sixteen pairs of identical twins (24 men, 8 women), aged 25-69 years. The dimensions of the lumbar vertebra L3 were measured from MR images and BMD values were corrected for these dimensions. The DXA-derived apparent volumetric bone mineral density (BMDvol) correlated moderately with MRI-derived BMDs (r values from 0.665 to 0.822). In contrast to BMDareal, BMDvol and MRI-derived BMDs were not related to body size variables. All these volume-corrected BMDs diminished the erroneous effect of vertebral size on areal BMD. We conclude that the simple DXA-derived BMDvol can be used for normalization of bone mineral density values in subjects of different body sizes, and especially in growing children.
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              Serum parathyroid hormone level is associated with body mass index. The 5th Tromsø study.

              To study whether serum parathyroid hormone (PTH) and serum calcium are associated with body mass index (BMI), and their predicting role in obesity. Population based, cross-sectional study. In 2001 a population-based health survey was held in Tromsø, North Norway. Questionnaires on medical history and life-style factors were completed and anthropometric data were collected. Calcium and vitamin D intakes and a physical activity score were calculated. Serum calcium and PTH were measured in a subset of 3447 men and 4507 women. Pearson correlation and linear regression were used to evaluate associations between BMI, PTH and serum calcium, and logistic regression was used to test PTH and serum calcium as predictors of obesity and to calculate odds ratio. Relative risk was calculated using frequency tables. For serum calcium and PTH there was a significant positive relation to BMI in both genders (P 4.20 pmol/l) was a significant predictor for obesity (P<0.001) in both genders, adjusted for age, physical activity and serum calcium. Obesity rates were higher in those with PTH levels in the highest quartile compared with those in the lower quartiles, which resulted in a relative risk of 1.40 (95% confidence interval (C.I.) 1.20-1.60) for men and 1.48 (95% C.I. 1.31-1.67) for women. Serum PTH, adjusted for age, physical activity and serum calcium, is positively associated with BMI in both sexes, and serum PTH is an independent predictor of obesity in our statistical model.
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                Author and article information

                Journal
                romm
                Revista de Osteoporosis y Metabolismo Mineral
                Rev Osteoporos Metab Miner
                Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (Madrid, Madrid, Spain )
                1889-836X
                2173-2345
                June 2022
                : 14
                : 2
                : 82-87
                Affiliations
                [01] Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Departamento de Medicina Spain
                [02] Sevilla orgnameHospital Universitario Virgen Macarena España
                [03] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio de Pediatría España
                [05] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio de Reumatología España
                [04] Sevilla orgnameHospital Universitario Virgen Macarena orgdiv1Servicio Medicina Interna España
                Article
                S1889-836X2022000200004 S1889-836X(22)01400200004
                10.4321/s1889-836x2022000200004
                ce204eb1-e52c-4a81-aba8-03a4e47b7b22

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 30 September 2021
                : 07 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 6
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                SciELO Spain

                Categories
                Originales

                diabetes mellitus tipo 1,longitudinal study,bone turnover,bone mineral density,childhood,type 1 diabetes mellitus,estudio longitudinal,recambio óseo,densidad mineral ósea,infancia

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