Total Calcium Intake Is Associated With Trabecular Bone Density in Adolescent Girls With Type 1 Diabetes

Rylee K Saunders; Kathleen M Kilroe; Taïsha V Joseph; Signe Caksa; Mary L Bouxsein; Madhusmita Misra; Deborah M Mitchell

doi:10.1002/jbm4.10813

Total Calcium Intake Is Associated With Trabecular Bone Density in Adolescent Girls With Type 1 Diabetes

JBMR Plus. 2023 Sep 19;7(11):e10813. doi: 10.1002/jbm4.10813. eCollection 2023 Nov.

Authors

Rylee K Saunders¹, Kathleen M Kilroe¹, Taïsha V Joseph¹, Signe Caksa¹, Mary L Bouxsein^{1

2}, Madhusmita Misra^{3

4}, Deborah M Mitchell^{1

3}

Affiliations

¹ Endocrine Unit Massachusetts General Hospital and Harvard Medical School Boston MA USA.
² Center for Advanced Orthopaedic Studies Beth Israel Deaconness Medical Center and Harvard Medical School Boston MA USA.
³ Division of Pediatric Endocrinology Massachusetts General Hospital and Harvard Medical School Boston MA USA.
⁴ Neuroendocrine Unit Massachusetts General Hospital and Harvard Medical School Boston MA USA.

Abstract

Type 1 diabetes (T1D) confers an increased risk of fracture and is associated with lower bone mineral density (BMD) and altered microarchitecture compared with controls. Adequate calcium (Ca) intake promotes bone mineralization, thereby increasing BMD. The objective of this analysis was to evaluate the associations of total daily Ca intake with bone outcomes among youth with T1D. This was a cross-sectional analysis of girls ages 10-16 years with (n = 62) and without (n = 60) T1D. We measured Ca intake with a validated food-frequency questionnaire and BMD, microarchitecture, and strength estimates with dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Total daily Ca intake did not differ between groups (950 ± 488 in T1D versus 862 ± 461 mg/d in controls, p = 0.306). Serum 25OHD was lower in T1D (26.3 ± 7.6 versus 32.6 ± 9.0 ng/mL, p = <0.001), and parathyroid hormone (PTH) was higher in T1D (38.9 ± 11 versus 33.4 ± 9.7 pg/mL, p = 0.004). Trabecular volumetric BMD and thickness at the tibia were lower in T1D (p = 0.013, p = 0.030). Ca intake correlated with trabecular BMD at the radius and tibia among T1D participants (β = 0.27, p = 0.047, and β = 0.28, p = 0.027, β = 0.28, respectively) but not among controls (p_interaction = 0.009 at the radius, p_interaction = 0.010 at the tibia). Similarly, Ca intake was associated with estimated failure load at the tibia in T1D but not control participants (p = 0.038, β = 0.18; p_interaction = 0.051). We observed the expected negative association of Ca intake with parathyroid hormone in controls (p = 0.022, β = -0.29) but not in T1D participants (p_interaction = 0.022). Average glycemia as measured by hemoglobin A1c did not influence the relationship of Ca and PTH among participants with T1D (p_interaction = 0.138). These data suggest that youth with T1D may be particularly vulnerable to dietary Ca insufficiency. Increasing Ca intake may be an effective strategy to optimize bone health in this population. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Keywords: BONE DENSITY; CALCIUM; PEDIATRICS; TYPE 1 DIABETES.

Abstract

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