Bone health in children and adolescents with type 1 and type 2 diabetes

The increasing prevalence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) among children and adolescents presents major challenges for long-term skeletal health. This review explores the effect of diabetes on bone health during critical phases of skeletal development. In T1D, insulin deficiency disrupts the insulin/insulin-like growth factor-1 axis, which is essential for osteoblast function, leading to decreased bone mineral density (BMD), lower bone formation markers, and altered microarchitecture. Conversely, T2D shows a paradoxical trend of normal or elevated BMD despite higher fracture risk, which is attributed to compromised bone quality from advanced glycation end-product accumulation and altered microarchitecture. Both types of diabetes share common pathophysiological mechanisms, including hyperglycemia, vitamin D deficiency, and oxidative stress, while also exhibiting distinct characteristics. Modern assessment techniques that go beyond conventional densitometry, such as trabecular bone score and high-resolution peripheral quantitative computed tomography, provide valuable insights into diabetes-specific bone abnormalities. Effective management strategies highlight the importance of strict glycemic control, adequate calcium and vitamin D supplementation, weight-bearing physical activities, and, when necessary, pharmacological interventions. Early identification and intervention are critical, as diabetes-related bone impairments during childhood can compromise peak bone mass development, potentially increasing the risk of lifelong fractures. As the prevalence of diabetes continues to rise globally, addressing bone health has become increasingly important for preventing future complications and ensuring good quality of life into adulthood.