Exploring the relationship between bone mineral density and bone biomarkers with the duration of childhood-onset type 1 diabetes in Kuwait
10 affiliations
- 1Department of Population Health, Dasman Diabetes Institute
- 2Pediatric Endocrine And Diabetes Unit, Pediatric Department, Farwaniya Hospital
- 3Adult Endocrine And Diabetes Unit, Internal Medicine Department, Farwaniya Hospital
- 4Department of Translational Research, Dasman Diabetes Institute
- 5Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute
- 6Adult Diabetes Division , Dasman Diabetes Institute
- 7Endocrinology and Diabetes Division, Internal Medicine Department, Jaber Al-Ahmad Hospital
- 8Department of Pediatric Endocrinology, Al Jalila Children’s Specialty Hospital
- 9Department of Paediatric Endocrinology and Metabolic Bone Diseases, Royal Manchester Children’s Hospital
- 10Faculty of Biology, Medicine and Health, University of Manchester
Abstract
Introduction: The significance of the human skeleton as an endocrine organ has been emphasized in recent literature where it may have the ability to regulate metabolic pathways including insulin signaling and glucose homeostasis. Therefore, the consequences of T1D can significantly impact bone health and structural formation, leading to osteoporosis later in life. This study aimed to evaluate lumbar spine size adjusted bone mineral density (BMD) and bone turnover biomarkers in Kuwaiti youth with childhood-onset T1D, and to examine its association with diabetes duration and glycemic control.
Methods: In this cross-sectional study, 132 Kuwaiti participants aged 5 to 18 years with T1D were recruited from a pediatric diabetes clinic. Anthropometric measurements, pubertal status, and clinical histories were recorded. Dual-energy X-ray absorptiometry (DXA; Hologic Discovery W, Hologic APEX Software version 5.6.0.5) was used to assess lumbar spine bone mineral apparent density (BMAD). Bone formation (osteocalcin, P1NP, P1CP) and resorption (urine CTX) biomarkers were measured. Multivariable linear regression models adjusted for age at diagnosis, sex, pubertal status, height, and HbA1c were used to assess associations between (i) diabetes duration and BMAD Z-score and (ii) diabetes duration and each bone biomarker.
Results: Median diabetes duration was 3.5 years (LQ-UQ: 1.01-6.98 years). Each additional year of diabetes duration was associated with a non-significant decrease in BMAD Z - score after adjustment for age at diagnosis, sex, Tanner pubertal status, average HbA1c, and height (effect size: –0.11, 95% CI: –0.22 to 0.01). Higher average HbA1c was significantly associated with lower BMAD Z - score (–0.18 per unit increase, p=0.005). Each additional year of diabetes duration was associated with lower osteocalcin levels by 30.6% (95%CI: 37.5-22.9%) amongst females and 14.5% (95% CI: 24.7-2.8%) amongst males, and lower Urine CTX levels by 14.3% amongst females (95% CI: 8.5-19.7%), but not amongst males.
Conclusion: Higher mean HbA1c was associated with a lower lumbar-spine BMAD Z-score, whereas diabetes duration was not significantly associated with BMAD Z-score. Sex-specific associations were observed between diabetes duration and selected bone-turnover markers. These cross-sectional findings require confirmation in longitudinal studies incorporating appropriately matched controls and population-appropriate DXA reference data.
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BibTeX
@article{alhomaidah2026exploring,
title = {{Exploring the relationship between bone mineral density and bone biomarkers with the duration of childhood-onset type 1 diabetes in Kuwait}},
author = {Doha Alhomaidah and Mohammed Hudda and Lujain Alabduljaleel and Fahad Alajmi and Abeer Altararwa and Jehad Abubaker and Irina Al-Khairi and Thamer Alessa and Mohamed Zulf Mughal and Raja Padidela and Mohamed Abu-Farha and Hessa Alkandari},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1857139},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1857139/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Exploring the relationship between bone mineral density and bone biomarkers with the duration of childhood-onset type 1 diabetes in Kuwait
AU - Doha Alhomaidah
AU - Mohammed Hudda
AU - Lujain Alabduljaleel
AU - Fahad Alajmi
AU - Abeer Altararwa
AU - Jehad Abubaker
AU - Irina Al-Khairi
AU - Thamer Alessa
AU - Mohamed Zulf Mughal
AU - Raja Padidela
AU - Mohamed Abu-Farha
AU - Hessa Alkandari
PY - 2026
DA - 2026/11/05
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1857139
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1857139/full
AB - Introduction: The significance of the human skeleton as an endocrine organ has been emphasized in recent literature where it may have the ability to regulate metabolic pathways including insulin signaling and glucose homeostasis. Therefore, the consequences of T1D can significantly impact bone health and structural formation, leading to osteoporosis later in life. This study aimed to evaluate lumbar spine size adjusted bone mineral density (BMD) and bone turnover biomarkers in Kuwaiti youth with childhood-onset T1D, and to examine its association with diabetes duration and glycemic control. Methods: In this cross-sectional study, 132 Kuwaiti participants aged 5 to 18 years with T1D were recruited from a pediatric diabetes clinic. Anthropometric measurements, pubertal status, and clinical histories were recorded. Dual-energy X-ray absorptiometry (DXA; Hologic Discovery W, Hologic APEX Software version 5.6.0.5) was used to assess lumbar spine bone mineral apparent density (BMAD). Bone formation (osteocalcin, P1NP, P1CP) and resorption (urine CTX) biomarkers were measured. Multivariable linear regression models adjusted for age at diagnosis, sex, pubertal status, height, and HbA1c were used to assess associations between (i) diabetes duration and BMAD Z-score and (ii) diabetes duration and each bone biomarker. Results: Median diabetes duration was 3.5 years (LQ-UQ: 1.01-6.98 years). Each additional year of diabetes duration was associated with a non-significant decrease in BMAD Z - score after adjustment for age at diagnosis, sex, Tanner pubertal status, average HbA1c, and height (effect size: –0.11, 95% CI: –0.22 to 0.01). Higher average HbA1c was significantly associated with lower BMAD Z - score (–0.18 per unit increase, p=0.005). Each additional year of diabetes duration was associated with lower osteocalcin levels by 30.6% (95%CI: 37.5-22.9%) amongst females and 14.5% (95% CI: 24.7-2.8%) amongst males, and lower Urine CTX levels by 14.3% amongst females (95% CI: 8.5-19.7%), but not amongst males. Conclusion: Higher mean HbA1c was associated with a lower lumbar-spine BMAD Z-score, whereas diabetes duration was not significantly associated with BMAD Z-score. Sex-specific associations were observed between diabetes duration and selected bone-turnover markers. These cross-sectional findings require confirmation in longitudinal studies incorporating appropriately matched controls and population-appropriate DXA reference data.
SN - 1664-2392
ER -