Bone Density Mass in Youth with Type 2 Diabetes -- T2D & Growing Bones - Diabetes In Control

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Author: Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy

A study examined bone density in young people with type 2 diabetes to assess the impact of type 2 on bone formation in maturing bodies.

Type 2 diabetes in youth is an aggressive disease with many risk factors. Increased fracture risks are known to occur in adults with type 2 diabetes, but sources state that this risk of diabetes is unknown for the maturing skeleton in youth. The purpose of this study was to evaluate bone health in childhood with type 2 diabetes. Previous studies have reported lower concentrations of bone formation markers in children with prediabetes and a murine model of early-onset type 2 diabetes.  Other cross-sectional studies examined whether type 2 diabetes duration may contribute to adults’ bone health deficits, but no research had been conducted in youth to determine this effect.  Another study looking at the abdominal visceral and subcutaneous fat reported a negative and positive relationship between the two; “with femoral bone geometry and estimated bone strength.” Recent epidemiological studies stated that fracture cases for youth with obesity are overrepresented. Many studies suggested that obesity-related factors, such as insulin resistance, impaired glucose tolerance, metabolic syndrome, and prediabetes, are possible disadvantages to childhood bone health.  

This study’s objective was to compare bone health in youth with type 2 diabetes to a population of control patients with obesity or healthy weight.  This study was a cross-sectional study; age 10-23 years old with 56% African American and 67% females with type 2 diabetes, obesity, or healthy weight.  The primary outcome was to compare the bone mass and density of youth with type 2 diabetes to a control group who had obesity or had a healthy weight. The secondary endpoints consisted of an analysis of bone and lean mass z scores between the groups and evaluating the correlation of abdominal fat deposits and bone outcomes.  

This study’s statistical analysis consisted of the following:  ANOVA or Kruskal-Wallis/Dunn’s tests with a Bonferroni post hoc to test comparison between the groups.  Pearson’s Chi-Square test determined the categorical variables between the groups. Pearson’s correlation determined the bivariate association for the time since diagnosis and age.  Anthropometric, lean body mass index (LBMI), and bone z scores were analyzed using linear regression. The predicted z scores for an age group used the regression model for calculation.  

The study’s three arms consisted of 180 patients with type 2 diabetes, 226 with obesity, and 238 with a healthy weight evaluated for the primary and secondary endpoints.  Since diagnosis with type 2 diabetes, the duration of time-correlated positively with the age groups at r = 0.62 and p-value of <0.001. The age-dependent differences in abdominal bone mineral density (aBMD) and lean body mass index (LBMI) z scores differed between the three study arms.  The aBMD and LBMI z scores were more significant in children with type 2 diabetes than the group with obesity.  The results for adolescents and younger adults were much lower in the type 2 diabetes group versus the obesity group with a p-value of < 0.05.  The type 2 diabetes group and the obesity group reported an aBMD that was around 0.5 standard deviations lower for LBMI z scores than the control healthy weight group, with a p-value of <0.05.  The study also determined that the aBMD was lower in patients with more significant visceral fat at a Beta of -0.121 and a p-value of 0.047.  Additional studies, including vitamin D as a parameter, resulted in aBMC z score remaining significant at a p-value of 0.006. Still, the result for aBMD z score was not statistically significant, with a p-value of 0.157. 

To conclude, the authors reiterated that this was the first study on bone health in youth with type 2 diabetes. The research suggests that type 2 diabetes may be harmful to bone density during the age of peak bone mass. The limitations of this study were that it was a cross-sectional study, and no generalizability.  Future studies are warranted to evaluate increased fracture risks in children with type 2 diabetes as it pertains to the growing skeleton.  This study is essential because these risk factors, as seen in adults, can occur in children.   

Practice Pearls: 

• Type 2 diabetes in youth comes with significant risk factors and comorbidities, including affecting bone health. 
• Healthy bone health in children can eliminate the risk of fractures, falls, and injuries.  
• Understanding how diabetes affects the growing skeleton in youth is the aim of future studies.  

Kindler JM, Kelly A, Khoury PR,  Bone Mass, and Density in Youth With Type 2 Diabetes, Obesity, and Healthy Weight. Diabetes Care. 2020 Oct;43(10):2544-2552. doi: 10.2337/dc19-2164. Diabetes Care Epub 2020 August 10.  

 

Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy 

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