Effect of gender, diabetes duration, inflammatory cytokines, and vitamin D level on bone mineral density among Thai children and adolescents with type 1 diabetes

Jeerunda Santiprabhob; Parichat Charoentawornpanich; Khwanhatai Khemaprasit; Teerarat Manpayak; Pornpimol Kiattisakthavee; Amornrat Pipatsathian; Nilrat Wannasilp; Watip Tangjittipokin

doi:10.1016/j.bone.2021.116112

Effect of gender, diabetes duration, inflammatory cytokines, and vitamin D level on bone mineral density among Thai children and adolescents with type 1 diabetes

Bone. 2021 Dec:153:116112. doi: 10.1016/j.bone.2021.116112. Epub 2021 Jul 10.

Authors

Jeerunda Santiprabhob¹, Parichat Charoentawornpanich², Khwanhatai Khemaprasit³, Teerarat Manpayak⁴, Pornpimol Kiattisakthavee⁵, Amornrat Pipatsathian⁶, Nilrat Wannasilp⁷, Watip Tangjittipokin⁸

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: jeerunda.san@mahidol.ac.th.
² Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: pari.choong@gmail.com.
³ Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: kkhwanhatai@gmail.com.
⁴ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: teerarat.man@mahidol.ac.th.
⁵ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: pornpimol.kia@mahidol.ac.th.
⁶ Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: amornrat.pip@mahidol.ac.th.
⁷ Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: nilrat.wan@mahidol.ac.th.
⁸ Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: watip.tan@mahidol.edu.

PMID: 34252600
DOI: 10.1016/j.bone.2021.116112

Abstract

Introduction: Type 1 diabetes mellitus (T1DM) is considered a risk factor for osteoporosis in adults; however, studies in bone mineral density (BMD) in children with T1DM reported conflicting results. The aim of this study was to compare BMD between T1DM youth and healthy controls, and to identify factors that affect BMD in T1DM youth.

Methods: One hundred T1DM youths and 100 healthy controls (both groups aged 5-20 years) were recruited. BMD of total body, lumbar (L2-4), femoral neck, and total hip were assessed using dual energy X-ray absorptiometry. Blood investigations, including hemoglobin A_1c (HbA_1c), 25-hydroxyvitamin D, and inflammatory cytokines, were performed.

Results: Forty-four boys and 56 girls with T1DM were enrolled [mean age 14.5 ± 2.7 years, median (IQR) duration of T1DM 5.80 (2.97-9.07) years, and mean HbA_{1c entire duration} 9.2 ± 1.4%]. T1DM girls had a lower height Z-score than control girls (p < 0.05), and 25-hydroxyvitamin D level was higher in T1DM youth than in controls (p < 0.001). After adjusting for pubertal status, height Z-score, and 25-hydroxyvitamin D, T1DM youth had a significantly lower lumbar BMD Z-score and femoral neck BMD than controls (p = 0.027 and p = 0.025, respectively). We also found that T1DM boys had a significantly lower lumbar BMD Z-score (p = 0.028), femoral neck BMD (p = 0.004), and total hip BMD (p = 0.016) than control boys. In contrast, these significant differences were not found in T1DM girls. Factors affecting BMD were different between T1DM boys and girls, and among different BMD sites. IL-13 was positively correlated with BMD in the total cohort and among girls. In boys - IL-2 and 25-hydroxyvitamin D were positively associated with BMD, and duration of diabetes was found to negatively affect BMD.

Conclusion: Deleterious effect of T1DM on BMD is gender specific. The longer the duration of T1DM, the greater the deficit in BMD found among boys with T1DM.

Keywords: 25-hydroxyvitamin D; Bone mineral density; Children and adolescents; Diabetes duration; Gender; Inflammatory cytokines; Type 1 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Absorptiometry, Photon
Adolescent
Adult
Bone Density
Child
Cytokines
Diabetes Mellitus, Type 1*
Female
Humans
Male
Thailand
Vitamin D

Substances

Cytokines
Vitamin D