Central European Annals of Clinical Research

(ISSN: 2668-7305) Open Access Journal
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Central European Annals of Clinical Research (CEACR) is no longer published on JAMS (the publishing platform provided by MDPI) as of 10.07.2021. The articles published until that date are archived at ceacr.archive.jams.pub by courtesy of JAMS.

Cent_Eur_Ann_Clin_Res 2020, 2(1), 17; doi:10.35995/ceacr2010017

Endoped Abstract
A Novel Method for Bone Health Assessment in Pediatric Patients with Type 1 Diabetes
Olga Slavcheva-Prodanova 1,*, Maia Konstantinova 1, Adelina Tsakova 2, Radka Savova 1 and Margarita Archinkova 1
University Childrens’ Hospital, Endocrinology, Diabetes and Genetics Department, Medical University Sofia, Acad Ivan Geshov blvd 11, 1612 Sofia, Bulgaria; maiakonstantinova@gmail.com (M.K.); savova_radka@yahoo.com (R.S.); archinkova@yahoo.com (M.A.)
Central Clinical Laboratory, Alexandrovska Hospital, Medical University Sofia, Sveti Georgi Sofiyski 1 str, 1431 Sofia, Bulgaria; adelina_d@abv.bg
Corresponding author: o.slavcheva@edu.mu-sofia.bg
How to cite: Slavcheva-Prodanova, O.; Konstantinova, M.; Tsakova, A.; Savova, R.; Archinkova, M. A Novel Method for Bone Health Assessment in Pediatric Patients with Type 1 Diabetes. Cent. Eur. Ann. Clin. Res. 2020, 2(1), 17; doi:10.35995/ceacr2010017.
Received: 20 October 2020 / Accepted: 14 November 2020 / Published: 17 November 2020
bone health; pediatrics; screening methods; type 1 diabetes

Background and Aims

Patients with type 1 diabetes (T1DM) have a 1.2–2.5 times higher risk for fractures [1], which is already evident at an early age [2]. Childhood and adolescence are crucial for peak bone mass (PBM) attainment. It was estimated that a 10% increase in PBM would delay osteoporosis onset by 13 years [3], whereas a 10% increase in the age of menopause would delay it by just 2 years [4]. Thus, simple and reliable methods for bone health screening in these patients are needed. Our aim was to assess bone health index (BHI) in pediatric patients with T1D and its relation to bone and calcium metabolism and disease-specific factors like: age at onset, duration, control and insulin dose.

Material and Methods

Sixty-five patients with T1DM and mean age 11.23 ± 3.89 years had left hand radiographs for bone age assessment completed. Their mean age at disease onset was 5.46 ± 3.35 years, mean disease duration 5.23 ± 3.76 years and mean HbA1c- 83 mmol/mol (9.7%). Blood and 24 h urine samples were collected for bone and mineral metabolism assessment. All patients were interviewed for calcium intake evaluation. BHI, BHI SDS and bone age were determined by the BoneXpert® program.


The mean BHI value was −4.41 ± 0.67 (n = 65), whereas the mean BHI SDS was −1.15 ± 1.19 (n = 54) with median −1.13 (−4.18 to 1.68). In 20.37% (n = 11), BHI SDS was <–2SD with mean value −2.82 ± 0. 69, p < 0.001. These patients had lower levels of beta cross laps (0.77 ± 0.33 ng/mL vs. 1.17 ± 0.47 ng/mL), osteocalcin (47.20 ± 14.07 ng/mL vs. 75.91 ± 32.08 ng/mL), serum magnesium (0.79 ± 0.05 mmol/L vs. 0.83 ± 0.06 mmol/L) and phosphorus (1.48 ± 0.29 mmol/L vs. 1.71 ± 0.28 mmol/L), but higher ionized calcium (1.29 ± 0.04 mmol/L vs. 1.26 ± 0.05 mmol/L), p < 0.05, compared to patients with BHI SDS in the normal range.
Patients with decreased BHI SDS had lower calcium intake as well (344.50 ± 155.36 mg per day vs. 1404.97 ± 360.67, p < 0.05). BHI had a positive correlation with IGF-1 level (r = 0.474, p = 0.001), whereas BHI SDS showed a negative one with disease duration (r = −0.284, p = 0.038). Both BHI and BHI SDS had positive correlations with age at disease onset (r = 0.484, p < 0.001 and r = 0.307, p = 0.024). No correlations were found with the other bone turnover markers, HbA1c, insulin dose, height, weight, or BMI.


Decreased cortical bone mineral density (cBMD) was observed in 20.37% of all examined patients. Earlier age at onset and longer diabetes duration appeared to be important factors in the determination of cBMD in patients with poor metabolic control. It would be of interest to follow up the observed changes in cBMD and/or to assess interventions like improved metabolic control, vitamin D and calcium supplementation, increased physical activity.


This work was supported by Grants from the Medical University Sofia, Bulgaria 55/2011 to M.K.; 10-D/2012 and 14-D/2013 to O.S. The funding organization had no role in data collection, analyses or final report of the study. The authors would like to thank all the children and adolescents for their participation in the study as well as their parents.

Conflicts of Interest

The authors declare no conflict of interest.


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