Stronger Foundations: Dr. Munier Nour on Bone Development in Diabetic Youth

Researchers Under the Scope

Dr. Munier Nour said osteoporosis is often seen as a disease that affects older adults. But compared to their peers, kids with Type 1 diabetes grow into adults eight times as likely to suffer bone fractures.

“Osteoporosis may actually have its origins during pediatric years,” he said. “Because Type 1 diabetes occurs so early in life ….. it influences that bone development that occurs during your peak growth.”

Now, Nour is a co-lead on a national team trying to figure out why.

The pediatric endocrinologist has always taken a logical approach to problem-solving. When he first enrolled at the University of Calgary, he took engineering courses, in case medicine didn’t work out.

Nour was accepted to medical school, where he found himself drawn to both pediatric intensive care and internal medicine, until one last-minute elective.

In this episode, Nour credits his supervisor, retired University of Calgary professor Dr. David Stephure, with changing his mind.

“It certainly wasn’t on my radar at all,” said Nour. “He was just a wonderful mentor. I think he really kind of sparked quite an interest and passion to pursue pediatric endocrinology.”

Nour completed his fellowship at the University of Calgary, along with his medical doctorate and master's degree in biomedical sciences. He completed his pediatric residency at Queen’s University, then joined the University of Saskatchewan’s College of Medicine in 2014. He spent his first year as the province’s lone pediatric endocrinologist.

Since then, the associate professor has embarked on a mission to understand why children with Type 1 diabetes exhibit a higher risk of impaired bone health and osteoporosis than their peers.

Nour said although it’s often overlooked as an endocrine organ, bone is ‘quite dynamic’, playing a crucial role in hormonal regulation.

“Some hormones produced by bone include things like fibroblast growth factor-23 (FGF23), which has a lot to do with our phosphate metabolism. As well, there's another hormone called osteocalcin, which actually has quite a role in diabetes as well,” said Nour.

Today, he and Dr. Saija Kontulainen are overseeing the Canadian Bone Strength Development in Children with Type 1 Diabetes Study: a national longitudinal study.

Using a grant of $1,352,140 from the Canadian Institutes of Health Research (CIHR) and with help from Diabetes Canada, they’re evaluating differences in bone development between children with Type 1 diabetes and their peers.

Dr. Nour said they’ll recruit up to 210 boys and girls between the ages of 10 and 12, tracking them over three years with annual bone health assessments. The study includes Saskatchewan patients, along with pre-teens in Calgary, Toronto and Ottawa.

Using high-resolution peripheral quantitative CT scans (HR-pQCT), hormonal measurements, muscle strength testing, bone density scans, and force plate tests, his team will assess key markers and differences in bone micro-architecture as the preteens’ radius and tibia grow.

“There's even fairly advanced engineering techniques that can be used to kind of simulate a fracture load and see when that bone would actually fail," said Nour.

Dr. Nour hopes this research will lead to interventions for children with type 1 diabetes that potentially strengthen their long-term bone health.

“So little is understood right now about what is different and why,” said Nour. “What can we do to prevent it?”