Diabetes and bone

Abstract

Globally, one in 11 adults has diabetes mellitus of which 90% have type 2 diabetes. The numbers for osteoporosis are no less staggering: 1 in 3 women has a fracture after menopause, and the same is true for 1 in 5 men after the age of 50 years. Aging is associated with several physiological changes that cause insulin resistance and impaired insulin secretion, which in turn lead to hyperglycemia. The negative balance between bone resorption and formation is a natural process that appears after the fourth decade of life and lasts for the following decades, eroding the bone structure and increasing the risk of fractures. Not incidentally, it has been acknowledged that diabetes mellitus, regardless of whether type 1 or 2, is associated with an increased risk of fracture. The nuances that differentiate bone damage in the two main forms of diabetes are part of the intrinsic heterogeneity of diabetes, which is enhanced when associated with a condition as complex as osteoporosis. This narrative review addresses the main parameters related to the increased risk of fractures in individuals with diabetes, and the mutual factors affecting the treatment of diabetes mellitus and osteoporosis. Arch

Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review

“…Overall, in terms of epidemiologic impact, 9 out of 10 individuals with diabetes have T2DM, but 1 out of 11 persons has any type of diabetes currently, both types being direct contributors to osteoporotic fractures [91,92]. Bone fragility in diabetes is caused by defects of mineralization and of trabecular microarchitecture in addition to other potential contributors to falling (as risk factor for fractures) such as diabetic sarcopenia, vitamin D deficiency, blood pressure and glycemic variations, impaired vision due to diabetic retinopathy, peripheral neuropathy, postural hypotension, foot amputation, etc.…”

“…While DXA-BMD and associated T-score represents the gold standard for osteoporosis diagnosis regardless of the presence of diabetes, TBS is mandatory in T2DM menopausal females, but others adult categories might benefit, too. TBS rather than BMD is associated with vertebral fractures in T2DM [91,[115][116][117]. FRAX (Fracture Risk Assessment) included T1DM as a secondary cause of osteoporosis, and not T2DM, while TBS-adjusted FRAX might prove useful in order to discriminate vertebral fractures [118].…”

Guideline for diagnostic, prevention and treatment of postmenopausal osteoporosis

“…However, to date, a number of factors have been found to have a significant impact on the risk of OPFs (evidence level 1++ and 1+): previous fragility fracture [38,39], hip fracture in parents [40], low body mass index (BMI) [41,42], smoking [43,44], excessive alcohol consumption [45][46][47][48], increased predisposition to falls [34,49], early or premature menopause [37,50], some diseases (rheumatoid arthritis [51][52][53]), endocrine diseases (type I [54,55] and type II diabetes mellitus [56,57]), thyroid diseases [58,59], inflammatory bowel diseases [60, 61], osteogenesis imperfecta [62], anorexia nervosa [63], etc.…”

Osteogenic Cells and Microenvironment of Early Bone Development and Clinical Implication

“…Another hypothesis proposes that prolonged high circulating glucose concentrations lead to advanced glycation end-products in circulation and resulting in collagen crosslinks in bone. Like bisphosphonate therapy, prolonged low bone turnover and changes in the biomechanical properties in T2DM create a more brittle bone that contributes to increased fracture risk [115,116].…”