Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes
Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes
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DOI：
10.1210/clinem/dgaa647
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发表时间：
2020-12-01
影响因子：
5.8
通讯作者：
Mitchell, Deborah M.
中科院分区：
文献类型：
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作者：
Joseph, Taisha, V;Caksa, Signe;Mitchell, Deborah M.
背景：在1型糖尿病(T1D)患者中，髋部骨折的风险比普通人群高6倍。目的：利用基于双能X线骨密度仪(DXA)的髋关节结构分析，评估患有T1D和不患有T1D的青年在髋关节几何形状和基于影像的骨强度估计方面的差异。设计：横断面比较。参与者：10-16岁的女孩，其中62名患有T1D，61名对照。结果：两组的年龄、骨龄、青春期、身高、瘦体重和体力活动相似。在单变量比较中，股骨颈和全髋部的骨密度没有差异，但在调整了骨龄、身高和瘦质量后，T1d时股骨颈的骨密度较低。患有T1D的受试者在狭窄的颈部的横截面面积、横截面转动惯量、横截面弹性模量和皮质厚度显著降低，其缺陷为5.7%~10.3%。T1D女孩的股骨粗隆间横截面积也较低。在HbA1c大于8.5%的T1D受试者中，髋关节几何和力量估计的缺陷更为明显。结论：基于DXA的髋部结构分析显示，患有T1D的女孩髋部的几何形状不佳，髋部骨强度估计较低，这可能是成年后骨骼脆性和过度髋部骨折风险的原因之一。较高的平均血糖可能会加重T1D对髋关节几何形状的影响。
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.