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Review
. 2025 Jul 23;17(15):2400.
doi: 10.3390/nu17152400.

Bone Health in Children and Adolescents with Type 1 Diabetes: Optimizing Bone Accrual and Preventing Fractures

Neriya Levran  1   2   3 , Einat Shalev-Goldman  1   4 , Yael Levy-Shraga  1   4
Affiliations
Review

Bone Health in Children and Adolescents with Type 1 Diabetes: Optimizing Bone Accrual and Preventing Fractures

Neriya Levran et al. Nutrients. .

Abstract

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D.

Keywords: bone health; fractures; nutrition; physical activity; type 1 diabetes.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Peak bone mass development and type 1 diabetes. Adapted with permission from Weaver et al. [9], licensed under CC BY-NC 4.0. Some modifications were made to the original figure. http://creativecommons.org/licenses/by-nc/4.0/, accessed on 18 July 2025.
Figure 2
Figure 2
Recommendations for optimizing bone health in children and adolescents with type 1 diabetes.
See this image and copyright information in PMC

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References

    1. Frohlich-Reiterer E., Elbarbary N.S., Simmons K., Buckingham B., Humayun K.N., Johannsen J., Holl R.W., Betz S., Mahmud F.H. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr. Diabetes. 2022;23:1451–1467. doi: 10.1111/pedi.13445. - DOI - PubMed
    1. Loxton P., Narayan K., Munns C.F., Craig M.E. Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis. Diabetes Care. 2021;44:1898–1905. doi: 10.2337/dc20-3128. - DOI - PMC - PubMed
    1. Zheng Y., Rostami Haji Abadi M., Ghafouri Z., Meira Goes S., Johnston J.J.D., Nour M., Kontulainen S. Bone deficits in children and youth with type 1 diabetes: A systematic review and meta-analysis. Bone. 2022;163:116509. doi: 10.1016/j.bone.2022.116509. - DOI - PubMed
    1. Madsen J.O.B., Herskin C.W., Zerahn B., Jorgensen N.R., Olsen B.S., Pociot F., Johannesen J. Decreased markers of bone turnover in children and adolescents with type 1 diabetes. Pediatr. Diabetes. 2020;21:505–514. doi: 10.1111/pedi.12987. - DOI - PubMed
    1. Weber D.R., Gordon R.J., Kelley J.C., Leonard M.B., Willi S.M., Hatch-Stein J., Kelly A., Kosacci O., Kucheruk O., Kaafarani M., et al. Poor Glycemic Control Is Associated With Impaired Bone Accrual in the Year Following a Diagnosis of Type 1 Diabetes. J. Clin. Endocrinol. Metab. 2019;104:4511–4520. doi: 10.1210/jc.2019-00035. - DOI - PMC - PubMed

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