{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:03:40Z","timestamp":1790388220395,"version":"4.1.0"},"reference-count":54,"publisher":"The Endocrine Society","issue":"8","funder":[{"DOI":"10.13039\/501100008175","name":"Glasgow Children's Hospital Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008175","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Type 1 diabetes (T1D) is associated with an increased fracture risk at all ages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To understand the determinants of bone health and fractures in children with T1D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Case-control study of children with T1D on bone-turnover markers, dual-energy X-ray absorptiometry, and 3 Tesla-MRI of the proximal tibia to assess bone microarchitecture and vertebral marrow adiposity compared with age- and sex-matched healthy children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty-two children with T1D at a median (range) age of 13.7 years (10.4, 16.7) and 26 controls, aged 13.8 years (10.2, 17.8), were recruited. In children with T1D, serum bone-specific alkaline phosphatase (BAP) SD score (SDS), C-terminal telopeptide of type I collagen SDS, and total body (TB) and lumbar spine bone mineral density (BMD) SDS were lower (all P &lt; 0.05). Children with T1D also had lower trabecular volume [0.55 (0.47, 0.63) vs 0.59 (0.47, 0.63); P = 0.024], lower trabecular number [1.67 (1.56, 1.93) vs 1.82 (1.56, 1.99); P = 0.004], and higher trabecular separation [0.27 (0.21, 0.32) vs 0.24 (0.20, 0.33); P = 0.001] than controls. Marrow adiposity was similar in both groups (P = 0.25). Bone formation, as assessed by BAP, was lower in children with poorer glycemic control (P = 0.009) and who were acidotic at initial presentation (P = 0.017) but higher in children on continuous subcutaneous insulin infusion (P = 0.025). Fractures were more likely to be encountered in children with T1D compared with controls (31% vs 19%; P&lt; 0.001). Compared with those without fractures, the T1D children with a fracture history had poorer glycemic control (P = 0.007) and lower TB BMD (P &lt; 0.001) but no differences in bone microarchitecture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children with T1D display a low bone-turnover state with reduced bone mineralization and poorer bone microarchitecture.<\/jats:p><\/jats:sec>","DOI":"10.1210\/jc.2019-00084","type":"journal-article","created":{"date-parts":[[2019,3,8]],"date-time":"2019-03-08T14:19:22Z","timestamp":1552054762000},"page":"3585-3594","source":"Crossref","is-referenced-by-count":45,"title":["Skeletal Fragility and Its Clinical Determinants in Children With Type 1 Diabetes"],"prefix":"10.1210","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2866-6360","authenticated-orcid":false,"given":"Suet Ching","family":"Chen","sequence":"first","affiliation":[{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom"},{"name":"Paediatric Diabetes Service, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McMillan","sequence":"additional","affiliation":[{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"McNeilly","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Royal Hospital for Children, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Clinical Physics, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze Choong","family":"Wong","sequence":"additional","affiliation":[{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J","family":"Robertson","sequence":"additional","affiliation":[{"name":"Paediatric Diabetes Service, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-5549","authenticated-orcid":false,"given":"S Faisal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,3,8]]},"reference":[{"issue":"4","key":"2019071105354744900_bib1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00198-006-0253-4","article-title":"Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes\u2014a meta-analysis","volume":"18","author":"Vestergaard","year":"2007","journal-title":"Osteoporos Int"},{"issue":"5","key":"2019071105354744900_bib2","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1002\/jbmr.2118","article-title":"Contemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from Scotland","volume":"29","author":"Hothersall","year":"2014","journal-title":"J Bone Miner Res"},{"key":"2019071105354744900_bib3","unstructured":"Royal College of Paediatrics and Child Health. 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