Type 1 Diabetes Mellitus and its Effects on Bone

Abstract

Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by destruction of pancreatic β-cells leading to absolute insulin deficiency. Beyond its metabolic complications, T1DM has significant adverse effects on skeletal health, particularly during childhood and adolescence, which are critical periods for bone mineral accrual. Children with T1DM are at increased risk of reduced bone mineral density (BMD), impaired bone quality, and future fractures due to multiple interconnected mechanisms including insulin deficiency, disruption of the insulin-like growth factor-1 (IGF-1) axis, chronic hyperglycemia, advanced glycation end-product accumulation, inflammatory cytokine activation, and osteocyte dysfunction. Disease duration, poor glycemic control, pubertal status, and alterations in calcium-phosphorus metabolism further contribute to skeletal impairment. Early identification of bone abnormalities in pediatric patients with T1DM is therefore essential to minimize long-term skeletal complications and improve quality of life.