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. 2020 Dec 1;105(12):e4848-e4856.
doi: 10.1210/clinem/dgaa647.

Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes

Taïsha V Joseph  1 , Signe Caksa  1 , Madhusmita Misra  2   3 , Deborah M Mitchell  1   2
Affiliations

Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes

Taïsha V Joseph et al. J Clin Endocrinol Metab. .

Abstract

Context: Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood.

Objective: To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis.

Design: Cross-sectional comparison.

Participants: Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls.

Results: The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced.

Conclusions: DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.

Trial registration: ClinicalTrials.gov NCT02140424.

Keywords: bone accrual; osteoporosis; type 1 diabetes.

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Figures

Figure 1.
Figure 1.
Bar charts showing percent difference ± standard error of the mean between participants with T1D and control subjects. 1A: Bone mineral density. 1B: HSA parameters at narrow neck. 1C: HSA parameters at intertrochanteric site. 1D: HSA parameters at femoral shaft. Abbreviations: BMD, bone mineral density; BR, buckling ratio; CSA, cross-sectional area; CSMI, cross-sectional moment of inertia; Ct Th, cortical thickness; EC width, endocortical width; FN, femoral neck; SP width, subperiosteal width; TH, total hip; Z, section modulus. *P < 0.05. Comparisons adjusted for height, lean mass, and bone age.
Figure 2.
Figure 2.
Bar chart showing percent difference ± standard error of the mean in BMD and HSA parameters at the narrow neck between control subjects and either T1D subjects with HbA1c ≤ 8.5% (T1D-controlled), or T1D subjects with HbA1c > 8.5% (T1D-uncontrolled). Abbreviations: BMD, bone mineral density; BR, buckling ratio; CSA, cross-sectional area; CSMI, cross-sectional moment of inertia; Ct Th, cortical thickness; EC width, endocortical width; FN, femoral neck; SP width, subperiosteal width; TH, total hip; Z, section modulus. *P < 0.05. Comparisons adjusted for height, lean mass, and bone age.
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References

    1. Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. 2007;18(12):1583-1593. - PubMed
    1. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495-505. - PubMed
    1. Shah VN, Shah CS, Snell-Bergeon JK. Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med. 2015;32(9):1134-1142. - PMC - PubMed
    1. Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR. Response to comment on Weber et al. type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care. 2015;38(12):e205-e206. - PMC - PubMed
    1. Abrahamsen B, Van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20(10):1633-1650. - PubMed

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