Abstract
Children and adolescents with poorly controlled type 1 diabetes mellitus (T1DM) are at risk for decreased bone mass. Growth hormone (GH) and its mediator, IGF-1, promote skeletal growth. Recent observations have suggested that children and adolescents with T1DM are at risk for decreased bone mineral acquisition. We examined the relationships between metabolic control, IGF-1 and its binding proteins (IGFBP-1, -3, -5), and bone mass in T1DM in adolescent girls 12–15 yr of age with T1DM (n = 11) and matched controls (n = 10). Subjects were admitted overnight and given a standardized diet. Periodic blood samples were obtained, and bone measurements were performed. Serum GH, IGFBP-1 and -5, glycosylated hemoglobin (HbA1c), glucose, and urine magnesium levels were higher and IGF-1 values were lower in T1DM compared with controls (p < 0.05). Whole body BMC/bone area (BA), femoral neck areal BMD (aBMD) and bone mineral apparent density (BMAD), and tibia cortical BMC were lower in T1DM (p < 0.05). Poor diabetes control predicted lower IGF-1 (r2 = 0.21) and greater IGFBP-1 (r2 = 0.39), IGFBP-5 (r2 = 0.38), and bone-specific alkaline phosphatase (BALP; r2 = 0.41, p < 0.05). Higher urine magnesium excretion predicted an overall shorter, lighter skeleton, and lower tibia cortical bone size, mineral, and density (r2 = 0.44–0.75, p < 0.05). In the T1DM cohort, earlier age at diagnosis was predictive of lower IGF-1, higher urine magnesium excretion, and lighter, thinner cortical bone (r2 ≥ 0.45, p < 0.01). We conclude that poor metabolic control alters the GH/IGF-1 axis, whereas greater urine magnesium excretion may reflect subtle changes in renal function and/or glucosuria leading to altered bone size and density in adolescent girls with T1DM.
Highlights
GOOD BONE HEALTH is important to the maintenance of functionality in the aging population
We conclude that poor metabolic control alters the Growth hormone (GH)/IGF-1 axis, whereas greater urine magnesium excretion may reflect subtle changes in renal function and/or glucosuria leading to altered bone size and density in adolescent girls with type 1 diabetes mellitus (T1DM)
Pubertal bone mineral accretion is predictive of osteoporosis in aging women.[1]. Recent observations suggest that children and adolescents with type 1 diabetes mellitus (T1DM) are at risk for decreased bone mineral acquisition.[2,3,4,5,6,7] Our research group has observed significantly lower bone mass in adolescents with T1DM compared with a nondiabetic reference population.[8,9] Children and adolescents with poorly controlled T1DM are at risk for decreased bone mass
Summary
GOOD BONE HEALTH is important to the maintenance of functionality in the aging population. Along with systemic GH and estradiol, local bone IGF-1 concentrations are regulated by PTH, 1,25-dihydroxyvitamin D3, and other cytokines and growth factors.[16] IGF-1 functions as a key anabolic regulator of bone cell activity by decreasing collagen degradation and increasing bone matrix deposition and osteoblastic cell recruitment.[15,16,17] In healthy children, serum IGF-1 concentrations correlate well with BMC.[18] In adolescents with poorly controlled T1DM, there is established evidence of increased secretion of GH but low levels of IGF-1 compared with matched controls.[13,17] the GH/IGF axis has received considerable attention as a mechanism for inadequate bone formation in T1DM.[19,20,21,22]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
