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Clinical Endocrinology

The impact of dysglycaemia on bone mineral accrual in young people with cystic fibrosis

Authors

  • Malay Rana,

    1. Institute of Endocrinology and Diabetes, Sydney Children's Hospital Network, Westmead, Australia
    2. School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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  • Craig F. Munns,

    1. Institute of Endocrinology and Diabetes, Sydney Children's Hospital Network, Westmead, Australia
    2. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
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  • Hiran Selvadurai,

    1. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
    2. Department of Respiratory Medicine, Sydney Children's Hospital Network, Westmead, Australia
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  • Julie Briody,

    1. Department of Nuclear Medicine, Sydney Children's Hospital Network, Westmead, Australia
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  • Maria E. Craig

    Corresponding author
    1. School of Women's and Children's Health, University of New South Wales, Sydney, Australia
    2. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
    • Institute of Endocrinology and Diabetes, Sydney Children's Hospital Network, Westmead, Australia
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Correspondence: Maria Craig, Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW, Australia. Tel.: +61 2 9845 3907; Fax: +612 9845 3170; E-mail: m.craig@unsw.edu.au

Summary

Objective

The effect of dysglycaemia on bone mineral density (BMD) has not been studied in young people with CF. We examined factors associated with BMD in a tertiary paediatric CF clinic.

Design

Retrospective, clinic-based study at The Children's Hospital at Westmead, Sydney.

Patients

Young people with CF aged ≤18 years.

Measurements

Bone mineral density was measured by dual-energy X-ray absorptiometry; main outcome measures were total body (TB), lumbar spine (LS) and femoral neck (FN) BMD and bone mineral content (BMC), and LS volumetric BMD (vBMD), reported as z scores for height. Dysglycaemia, based on oral glucose tolerance test, was defined as CF-related diabetes (CFRD) or impaired glucose tolerance (IGT).

Results

Overall, 14 of 81 (17%) had CFRD, 6 (7%) IGT and 61 (76%) normal glucose tolerance (NGT). Mean age was 14·9 ± 2·4 years and mean height z score −0·68 ± 1·39. Osteopenic (z score ≤−2) TB, LS or FN BMD was present in 30 of 81 (37%), BMC in 42 (52%) and vBMD in 10 (5%). Across the three groups, there were differences in LS vBMD (CFRD, −0·67 ± 0·76; IGT, −0·52 ± 0·76; NGT, −0·05 ± 1·39; P = 0·04), LS BMD (< 0·01), LS BMC (= 0·01) and TB BMD (= 0·01). In multivariate linear regression, LS BMC was associated with dysglycaemia (β = 0·56; 95% CI, 0·00–1·13; = 0·05) and approached significance for FEV1 (β = 0·01; 95% CI, 0·00–0·02; = 0·06).

Conclusions

Dysglycaemia is associated with reduced bone mass accrual in youth with CF, in addition to recognized factors such as abnormal lung function, poor nutritional status and disease severity. Bone health assessment is essential in youth with CF.

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