Type 1 Diabetes in Youth Linked to Progressive Decline in Bone Health: Study
A four-year study of 200 children and adolescents with type 1 diabetes has found significant declines in bone density and structure, particularly among those with a longer disease duration. Bone mineral density Z-scores decreased from −1.4 to −1.7, while trabecular bone density fell from 167.7 to 150.2 mg/cm³ and cortical thickness declined from 3.1 to 1.8 mm. As adolescence is a critical period for achieving peak bone mass, these changes may increase the risk of impaired skeletal development and fractures later in life. Early identification of high-risk children and regular longitudinal monitoring may help protect long-term bone health.
The study was published in the journal Bone by Shruti M. and colleagues. The long-term bone density changes as well as geometrical properties were assessed through a single center, retrospective cohort study conducted at a tertiary care center in Western Maharashtra, India between December 2015 and December 2022 on participants of the Sweetlings cohort. A cohort of 200 children and adolescents was followed up prospectively for 4 years.
Investigators took routine longitudinal measures that included body anthropometry, body composition, systemic biochemical parameters and multi-modal bone assessments. A BMD was measured using dual energy X-ray absorptiometry (DXA) for total body less head (TBLH). Volumetric BMD as well as geometrical assessments were performed by pQCT.
Key findings:
- Total of 200 subjects (mean age: 10.6 ± 3.9 years; diabetes duration: 3.2 ± 3.2 years) were studied for four years.
- Glycaemic control deteriorated, with higher demand for insulin and HbA1c levels as well as lower insulin sensitivity. Reduction in TBLH aBMD Z-scores from (−1.4 ± 1.1 to −1.7 ± 1.2) was seen.
- The study revealed reductions in trabecular vBMD (from 167.7 ± 35.6 to 150.2 ± 39.8 mg/cm3), trabecular density for age Z-scores (−0.9 ± 1.5 to −1.7 ± 1.2), and total density for age Z-scores (−0.5 ± 1.5 to −1.0 ± 1.0) as well as in cortical thickness, while an increase in cortical vBMD.
- Subjects with diabetes duration ≥5 years showed poor insulin sensitivity, lean body mass, and bone variables at baseline and follow-up, with greater decline in trabecular and total volumetric BMD.
- Significant factors were sex, pubertal status, glycaemic control, disease duration, and dyslipidemia.
The study findings show that individuals suffering from T1DM exhibit progressive decline in bone health over time, especially those with prolonged periods of illness and unfavorable metabolic status. The early detection of high-risk patients with such metabolic risk factors as dysglycemia, dyslipidemia, or prolonged duration of diabetes will help endocrinologists develop preventive measures to sustain good bone health throughout life.
Reference:
Mondkar, S., Karuggipkar, M., Deshpande, M., Khadilkar, A., Gondhalekar, K., & Khadilkar, V. (2026). Progressive deterioration of bone density and geometry in children and adolescents with type 1 diabetes: A 4-year DXA and pQCT based study. Bone, 212, 118018. https://doi.org/10.1016/j.bone.2026.118018
