The risks of sarcopenia, falls and fractures in patients with type 2 diabetes mellitus

Sarodnik, Cindy; Bours, S.; Schaper, Nicolaas C.; Bergh, Joop van den; Geel, Tineke van

doi:10.1016/j.maturitas.2017.12.011

Cited by 68 publications

(50 citation statements)

References 139 publications

(183 reference statements)

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“…Indeed, as compared to nondiabetic subjects, the risk of falling more than once a year is known to be increased in older women with T2DM without insulin use and even higher in insulin users [54]. Sarcopenia, the age-related decline in skeletal muscle mass, quality, and function, may represent an additional contributing factor to the increased fall and fracture [57], and it is known to be associated with T2DM. Indeed, in T2DM patients, both muscle strength and function are decreased as compared to nondiabetic subjects [58,59].…”

Section: Factors Leading To Bone Fragility In T2dmmentioning

confidence: 99%

Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

Eller-Vainicher

Cairoli

Grassi

et al. 2020

Journal of Diabetes Research

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Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of bone fragility fractures compared to nondiabetic subjects. This increased fracture risk may occur despite normal or even increased values of bone mineral density (BMD), and poor bone quality is suggested to contribute to skeletal fragility in this population. These concepts explain why the only evaluation of BMD could not be considered an adequate tool for evaluating the risk of fracture in the individual T2DM patient. Unfortunately, nowadays, the bone quality could not be reliably evaluated in the routine clinical practice. On the other hand, getting further insight on the pathogenesis of T2DM-related bone fragility could consent to ameliorate both the detection of the patients at risk for fracture and their appropriate treatment. The pathophysiological mechanisms underlying the increased risk of fragility fractures in a T2DM population are complex. Indeed, in T2DM, bone health is negatively affected by several factors, such as inflammatory cytokines, muscle-derived hormones, incretins, hydrogen sulfide (H2S) production and cortisol secretion, peripheral activation, and sensitivity. All these factors may alter bone formation and resorption, collagen formation, and bone marrow adiposity, ultimately leading to reduced bone strength. Additional factors such as hypoglycemia and the consequent increased propensity for falls and the direct effects on bone and mineral metabolism of certain antidiabetic medications may contribute to the increased fracture risk in this population. The purpose of this review is to summarize the literature evidence that faces the pathophysiological mechanisms underlying bone fragility in T2DM patients.

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Section: Factors Leading To Bone Fragility In T2dmmentioning

confidence: 99%

Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

Eller-Vainicher

Cairoli

Grassi

et al. 2020

Journal of Diabetes Research

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“…Therefore, protection of muscle strength should be an essential part of good diabetes treatment. The exact mechanisms behind the development of sarcopenia are not quite clear, but it represents a multifactorial process leading to catabolism with a deficit in protein synthesis [119]. Insulin is a strong anabolic hormone that improves protein synthesis [120].…”

Section: Frailty and Sarcopeniamentioning

confidence: 99%

“…As shown in a large registry study in older patients with type 2 diabetes, the excess risk of dementia with two episodes of SH increased to an HR of 1.86 if adjusted for comorbidities [ 118 ]. Moreover, old patients have an increased incidence of CV complications and arrhythmias during SHs [ 119 ]. However, as shown in the ORIGIN study [ 85 ] and by an acute care unit study [ 81 ], insulin-treated patients have fewer complications and lower mortality in the case of SH.…”

Section: Special Populations (Elderly Frailty)mentioning

confidence: 99%

Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update

Hanefeld

Fleischmann

Siegmund³

et al. 2020

Diabetes Ther

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Type 2 diabetes is characterised by chronic hyperglycaemia and variable degrees of insulin deficiency and resistance. Hyperglycaemia and elevated fatty acids exert harmful effects on bcell function, regeneration and apoptosis (gluco-lipotoxicity). Furthermore, chronic hyperglycaemia triggers a vicious cycle of insulin resistance, low-grade inflammation and a cascade of pro-atherogenic processes. Thus,

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“…Evidence from multiple observational studies has documented a positive association between sarcopenia and risk of both falls (pooled OR 1.60, 95% CI 1.37-1.86 in crosssectional studies; pooled OR 1.89, 95% CI 1.33-2.68 in prospective studies) and fractures (pooled OR 1.84, 95% CI 1.30-2.62 in crosssectional studies; pooled OR 1.71, 95% CI 1.44-2.03 in prospective studies) [70]. Consequently, sarcopenia may be considered as an extraskeletal factor that increases the risk of falls and fractures in patients with T2D [71].…”

Section: Type 2 Diabetes Sarcopenia Falls and Risk Of Fracturementioning

confidence: 99%

Diabetes and Bone Fragility

et al. 2020

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Diabetes is a highly prevalent disease with complications that impact most bodily systems. However, the impact of diabetes on bone health is frequently ignored or underestimated. Both type 1 (T1D) and type 2 diabetes (T2D) are associated with a higher risk of fractures, albeit through different mechanisms. T1D is characterized by near total insulinopenia, which affects the anabolic tone of bone and results in reduced bone mineral density (BMD). Meanwhile, patients with T2D have normal or high BMD, but carry an increased risk of fractures due to alterations of bone microarchitecture and a local humoral environment that stimulates osteoclast activity. Chronic hyperglycemia induces non-enzymatic glycation of collagen in both types of diabetes. Epidemiological evidence confirms a largely increased fracture risk in T1D and T2D, but also that it can be substantially reduced by opportune monitoring of fracture risk and appropriate treatment of both diabetes itself and osteopenia or osteoporosis if they are present. In this review, we summarize the mechanistic, epidemiological, and clinical evidence that links diabetes and bone fragility, and describe the impact of available diabetes treatments on bone health.

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The risks of sarcopenia, falls and fractures in patients with type 2 diabetes mellitus

Cited by 68 publications

References 139 publications

Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update

Diabetes and Bone Fragility

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