Bone turnover markers in children and adolescents with type 1 diabetes—A systematic review

Type 1 diabetes (T1D) is associated with impaired bone health and both osteocalcin (OCN) and procollagen type 1 amino terminal propetide (P1NP) (markers of bone formation) and C‐terminal cross‐linked telopeptide (CTX) (marker of bone resorption) are decreased in adult patients with T1D. We review th...

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Bibliographic Details
Published in:Pediatric diabetes 2019-08, Vol.20 (5), p.510-522, Article pedi.12853
Main Authors: Madsen, Jens O. B., Jørgensen, Niklas R., Pociot, Flemming, Johannesen, Jesper
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Biomarkers - blood
Bone growth
Bone Remodeling
Bone resorption
Bone turnover
Child
Children
Collagen
Collagen Type I - blood
Correlation analysis
Diabetes
Diabetes mellitus
Diabetes mellitus (insulin dependent)
Diabetes Mellitus, Type 1 - blood
Glycated Hemoglobin A - metabolism
Hemoglobin
Humans
Osteocalcin
Osteocalcin - blood
Osteogenesis
Peptide Fragments - blood
Peptides - blood
Procollagen
Procollagen - blood
Teenagers
type 1 diabetes
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Summary:Type 1 diabetes (T1D) is associated with impaired bone health and both osteocalcin (OCN) and procollagen type 1 amino terminal propetide (P1NP) (markers of bone formation) and C‐terminal cross‐linked telopeptide (CTX) (marker of bone resorption) are decreased in adult patients with T1D. We review the existing literature characterizing these bone turnover markers in children and adolescents with T1D and by meta‐analysis examine whether alterations in OCN, P1NP, and CTX are evident and if potential changes correlate to the metabolic control (hemoglobin A1c, HbA1c). Systematic searches at MEDLINE and EMBASE were conducted in January 2018 identifying all studies describing OCN, P1NP, or CTX in children and adolescents with T1D. A total of 26 studies were included, representing data from more than 1000 patients with T1D. Pooled analyses of standard mean difference and summary effects analysis were performed when sufficient data were available. Pooled analysis revealed mean OCN to be significantly lower in children and adolescents with T1D compared to healthy controls (standard mean difference: −1.87, 95% confidence interval, CI: −2.83; −0.91) whereas both P1NP and CTX did not differ from the controls. Only data on OCN was sufficient to make pooled correlation analysis revealing a negative correlation between OCN and HbA1c (−0.31 95% CI: −0.45; −0.16). In conclusion, OCN is decreased in children and adolescents with T1D, whether CTX and P1NP are affected as well is unclear, due to very limited data available. New and large studies including OCN, P1NP, and CTX (preferably as z‐scores adjusting for age variability) is needed to further elucidate the status of bone turnover in children and adolescents with T1D.
ISSN:1399-543X
1399-5448
DOI:10.1111/pedi.12853