Type 2 diabetes adversely affects bone mass in youth
medwireNews: Youth with type 2 diabetes have lower areal bone mineral density (aBMD) than those with obesity or who are of normal weight, according to the results of a cross-sectional study.
This is important, say Babette Zemel (Children’s Hospital of Philadelphia, Pennsylvania, USA) and co-authors in Diabetes Care, as “childhood is a critical period of bone accrual.”
Zemel and co-workers “observed age-dependent differences in skeletal measures between individuals with type 2 diabetes and obesity that suggest an adverse influence of diabetes on aBMD during the critical window of peak bone mass attainment.”
The influence of diabetes on the growing skeleton was unknown before their study, note the researchers, who analyzed data on 644 children and adolescents aged between 10 and 23 years (56% African American, 67% female) who had been seen at diabetes clinics in Cincinnati in Ohio, USA. In total, 180 participants had type 2 diabetes, 226 had obesity, and 238 were of healthy weight.
Significant differences were found in aBMD and lean BMI z scores between children and young people in the type 2 diabetes group whereas they were more stable across the ages in the obese and healthy weight groups.
For instance, there was an age-related decline in bone z scores in the type 2 diabetes group; the predicted aBMD z scores at 10 years of age versus 24 years of age were a respective 1.30 and 0.57. By comparison, the predicted aBMD z scores were 0.78 and 0.94 in the obese group and 0.36 and 0.57 in the healthy weight group.
aBMD was significantly lower in the type 2 diabetes group and the obese group for a given lean BMI z score compared with healthy weight controls, by about 0.5 standard deviations. aBMD was found to be lower in those with greater visceral fat.
“z score values should be stable across childhood,” Zemel et al observe. The decline seen in the type 2 diabetes group “suggests a potentially adverse influence of type 2 diabetes on bone health irrespective of obesity.” This is “particularly concerning,” they add, suggesting that the lower score was more likely due to less bone accretion than bone loss, but that sexual maturation and stature may also factor in.
“Prospective studies are needed to further understand the effects of type 2 diabetes on bone accrual during critical periods of growth as these discrepancies may have lasting effects on risk of fragility fractures later in life,” the team concludes.
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