---
title: "Sex- and Pubertal Stage–Specific Bone Microarchitecture and Strength in Adolescents with Type 1 Di"
id: "pubmed-41968580"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41968580"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41968580/"
doi: "10.1210/clinem/dgag161"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Sex- and Pubertal Stage–Specific Bone Microarchitecture and Strength in Adolescents with Type 1 Di
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41968580
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41968580/)
- **DOI:** [10.1210/clinem/dgag161](https://doi.org/10.1210%2Fclinem%2Fdgag161)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Context: Adults with **type 1 diabetes** (T1D) have higher fracture risk; the impact of T1D on adolescent bone accrual is not well defined. - Objective: Evaluate differences in bone microarchitecture and strength between adolescents with T1D and matched controls across sex-specific pubertal stages. - Design: Cross-sectional study at a tertiary medical center comparing 40 youth with T1D and 40 matched controls during sex-specific stages of pubertal bone accrual (early-pubertal girls, mid-pubertal boys). - Assessments: Dual-energy X-ray absorptiometry (DXA); **high-resolution peripheral quantitative computed tomography (HR-pQCT)** with individual trabecula segmentation; micro-finite element analysis for failure load/strength; laboratory measures including **HbA1c**, continuous glucose monitoring (**CGM**), skin autofluorescence (SAF) pentosidine as an **advanced glycation end-product** proxy, insulin-like growth factor-1 (**IGF-1**), and bone turnover markers. - Main results (boys): Compared with control boys, boys with T1D showed lower distal tibia trabecular bone volume fraction (-14%; P = .033), fewer plate-like trabeculae (-23%; P = .007), and reduced failure load (-12%; P = .008). They also had lower cortical area (-8%; P = .026) at the proximal tibia and similar deficits at the radius. - Main results (girls): Early-pubertal girls with T1D showed no detectable deficits compared with control girls. - Associations: In boys, higher **HbA1c** associated with fewer plate-like trabeculae (β = -0.31, P = .038) and reduced strength. Lower **IGF-1** predicted lower trabecular volume and strength. Across the T1D cohort, CGM-measured hyperglycemia and higher **SAF** correlated with suppressed bone turnover. - Conclusion: Skeletal effects of T1D are **sex- and pubertal stage–specific**. Mid-pubertal boys represent a critical window of vulnerability with trabecular and cortical deficits and reduced bone strength, while early-pubertal girls did not show deficits in this cohort. - Implication: Mid-puberty in boys with T1D may be an important time for targeted monitoring or intervention to protect bone accrual.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/41968580/#linkout) Title & authors Abstract Similar articles References MeSH terms Substances Related information Grants and funding LinkOut - more resources J Clin Endocrinol Metab Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Clin+Endocrinol+Metab%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Clin+Endocrinol+Metab%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41968580/) . 2026 Sep 16;111(10):2931-2945. doi: 10.1210/clinem/dgag161. # Sex- and pubertal stage-specific bone microarchitecture and strength in adolescents with type 1 diabetes [Aiden V Brossfield](https://pubmed.ncbi.nlm.nih.gov/?term=Brossfield+AV&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Kristen M Williams](https://pubmed.ncbi.nlm.nih.gov/?term=Williams+KM&cauthor_id=41968580)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-2 "Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA."), [Tony J Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+TJ&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Joana Gjeci](https://pubmed.ncbi.nlm.nih.gov/?term=Gjeci+J&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Alaa Ali](https://pubmed.ncbi.nlm.nih.gov/?term=Ali+A&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Dharam V Mathur](https://pubmed.ncbi.nlm.nih.gov/?term=Mathur+DV&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Aastha Mehta](https://pubmed.ncbi.nlm.nih.gov/?term=Mehta+A&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Noelle G Texeira](https://pubmed.ncbi.nlm.nih.gov/?term=Texeira+NG&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Donald J McMahon](https://pubmed.ncbi.nlm.nih.gov/?term=McMahon+DJ&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Sanchita Agarwal](https://pubmed.ncbi.nlm.nih.gov/?term=Agarwal+S&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [X Edward Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+XE&cauthor_id=41968580)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-3 "Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA."), [Aviva B Sopher](https://pubmed.ncbi.nlm.nih.gov/?term=Sopher+AB&cauthor_id=41968580)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-4 "Division of Pediatric Endocrinology, Columbia University, New York, NY 10032, USA."), [Mishaela R Rubin](https://pubmed.ncbi.nlm.nih.gov/?term=Rubin+MR&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#full-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA.") Affiliations Expand ### Affiliations * 1 Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA. * 2 Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA. * 3 Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. * 4 Division of Pediatric Endocrinology, Columbia University, New York, NY 10032, USA. * PMID: **41968580** * PMCID: **PMC13577747** (available on 2027-04-11) * DOI: [ 10.1210/clinem/dgag161 ](https://doi.org/10.1210/clinem/dgag161) Item in Clipboard # Sex- and pubertal stage-specific bone microarchitecture and strength in adolescents with type 1 diabetes Aiden V Brossfield et al. J Clin Endocrinol Metab. 2026. Show details Display options Display options Format Abstract PubMed PMID J Clin Endocrinol Metab Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Clin+Endocrinol+Metab%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Clin+Endocrinol+Metab%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41968580/) . 2026 Sep 16;111(10):2931-2945. doi: 10.1210/clinem/dgag161. ### Authors [Aiden V Brossfield](https://pubmed.ncbi.nlm.nih.gov/?term=Brossfield+AV&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Kristen M Williams](https://pubmed.ncbi.nlm.nih.gov/?term=Williams+KM&cauthor_id=41968580)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-2 "Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA."), [Tony J Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+TJ&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Joana Gjeci](https://pubmed.ncbi.nlm.nih.gov/?term=Gjeci+J&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Alaa Ali](https://pubmed.ncbi.nlm.nih.gov/?term=Ali+A&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Dharam V Mathur](https://pubmed.ncbi.nlm.nih.gov/?term=Mathur+DV&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Aastha Mehta](https://pubmed.ncbi.nlm.nih.gov/?term=Mehta+A&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Noelle G Texeira](https://pubmed.ncbi.nlm.nih.gov/?term=Texeira+NG&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Donald J McMahon](https://pubmed.ncbi.nlm.nih.gov/?term=McMahon+DJ&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [Sanchita Agarwal](https://pubmed.ncbi.nlm.nih.gov/?term=Agarwal+S&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA."), [X Edward Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+XE&cauthor_id=41968580)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-3 "Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA."), [Aviva B Sopher](https://pubmed.ncbi.nlm.nih.gov/?term=Sopher+AB&cauthor_id=41968580)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-4 "Division of Pediatric Endocrinology, Columbia University, New York, NY 10032, USA."), [Mishaela R Rubin](https://pubmed.ncbi.nlm.nih.gov/?term=Rubin+MR&cauthor_id=41968580)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41968580/#short-view-affiliation-1 "Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA.") ### Affiliations * 1 Metabolic Bone Disease Unit, Columbia University, New York, NY 10032, USA. * 2 Naomi Berrie Diabetes Center, Columbia University, New York, NY 10032, USA. * 3 Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. * 4 Division of Pediatric Endocrinology, Columbia University, New York, NY 10032, USA. * PMID: **41968580** * PMCID: **PMC13577747** (available on 2027-04-11) * DOI: [ 10.1210/clinem/dgag161 ](https://doi.org/10.1210/clinem/dgag161) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Context:** Adults with type 1 diabetes (T1D) have elevated fracture risk, but the effects of T1D on bone accrual during adolescence remain unclear. **Objective:** To assess group differences in bone microarchitecture and strength between adolescents with type 1 diabetes and controls during sex-specific stages of pubertal bone accrual. **Methods:** In this cross-sectional study at a tertiary medical center, forty youth with T1D and 40 matched controls were studied during early-pubertal (Tanner 2-3, girls) and mid-pubertal (Tanner 3-4, boys) stages of bone accrual. Assessments included dual-energy X-ray absorptiometry, high-resolution peripheral quantitative computed tomography (HR-pQCT) with individual trabecula segmentation, and micro-finite element analysis, as well as HbA1c, continuous glucose monitoring (CGM), advanced glycation end-products (skin autofluorescence [SAF] pentosidine), insulin-like growth factor-1 (IGF-1), and bone turnover markers. **Results:** Compared with control boys, boys with T1D had lower trabecular bone volume fraction (-14%; P = .033), plate-like trabeculae (-23%; P = .007), and failure load (-12%; P = .008) at the distal tibia and lower cortical area (-8%; P = .026) at the proximal tibia, with similar deficits at the radius. In contrast, compared with control girls, girls with T1D in early puberty showed no deficits. In boys, higher HbA1c was linked to fewer plate-like trabeculae (β = -.31, P = .038) and reduced strength, while lower IGF-1 predicted decreased trabecular volume and strength. Across the T1D cohort, CGM hyperglycemia and higher SAF correlated with suppressed bone turnover. **Conclusion:** Type 1 diabetes exerts sex- and pubertal stage-specific skeletal effects. Mid-pubertal boys show trabecular and cortical deficits with reduced strength, whereas early-pubertal girls show no deficits. Mid-puberty in boys represents a critical window for skeletal vulnerability and potential intervention. **Keywords:** HR-pQCT; adolescence; bone microarchitecture; bone strength; puberty; type 1 diabetes. © The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Elevated HbA1c Is Associated with Altered Cortical and Trabecular Microarchitecture in Girls with Type 1 Diabetes. ](https://pubmed.ncbi.nlm.nih.gov/31761940/) Mitchell DM, Caksa S, Joseph T, Bouxsein ML, Misra M.Mitchell DM, et al.J Clin Endocrinol Metab. 2020 Apr 1;105(4):e1648-56. doi: 10.1210/clinem/dgz221.J Clin Endocrinol Metab. 2020.PMID: 31761940Free PMC article. * [ Rapid growth produces transient cortical weakness: a risk factor for metaphyseal fractures during puberty. ](https://pubmed.ncbi.nlm.nih.gov/20200962/) Wang Q, Wang XF, Iuliano-Burns S, Ghasem-Zadeh A, Zebaze R, Seeman E.Wang Q, et al.J Bone Miner Res. 2010 Jul;25(7):1521-6. doi: 10.1002/jbmr.46.J Bone Miner Res. 2010.PMID: 20200962 * [ Bone parameters in T1D and T2D assessed by DXA and HR-pQCT - A cross-sectional study: The DIAFALL study. ](https://pubmed.ncbi.nlm.nih.gov/37001628/) Rasmussen NH, Dal J, Kvist AV, van den Bergh JP, Jensen MH, Vestergaard P.Rasmussen NH, et al.Bone. 2023 Jul;172:116753. doi: 10.1016/j.bone.2023.116753. Epub 2023 Mar 29.Bone. 2023.PMID: 37001628 * [ Contributions of Bone Microarchitecture to Skeletal Fragility in Adults with Longstanding Type 1 Diabetes. ](https://pubmed.ncbi.nlm.nih.gov/41870579/) Marion LA, Johannesdottir F, Nevarez CE, Wang JY, Jung GH, Decurtis RZ, Fremaint AI, Cagliero E, Aroda VR, Bouxsein ML, Yu EW.Marion LA, et al.J Bone Miner Res. 2026 Mar 23:zjag054. doi: 10.1093/jbmr/zjag054. Online ahead of print.J Bone Miner Res. 2026.PMID: 41870579Free PMC article. * [ Bone deficits in children and youth with type 1 diabetes: A systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/35914713/) Zheng Y, Rostami Haji Abadi M, Ghafouri Z, Meira Goes S, Johnston JJD, Nour M, Kontulainen S.Zheng Y, et al.Bone. 2022 Oct;163:116509. doi: 10.1016/j.bone.2022.116509. Epub 2022 Jul 29.Bone. 2022.PMID: 35914713 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=41968580) ## References 1. 1. Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR. Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care. 2015;38(10):1913‐1920. - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC4580610/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26216874/) 2. 1. Vi
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