Bone Quality and Fracture-Healing in Type-1 and Type-2 Diabetes Mellitus

Abstract

➤ Patients with type-1 or type-2 diabetes have an increased risk of fracture, which is secondary to early bone loss in type-1 diabetes whereas, in type 2, the development of abnormal osseous architecture results in paradoxically increased or normal bone mineral density.➤ Diabetic patients diagnosed with osteoporosis should receive the same standard antiresorptive therapies as non-diabetic patients in conjunction with appropriate glycemic control.➤ Medical management of type-2 diabetes can affect bone health and fracture risk. Thiazolidinediones have been correlated with an increased facture risk, whereas metformin can be protective of the bone health of diabetic patients.➤ Diabetes increases the likelihood of nonunion and delayed union of fractures as well as other perioperative complications such as infection.➤ Perioperative glycemic control may decrease the risk of perioperative complications, especially surgical site infection. Methods to directly improve diabetic fracture-healing such as the use of parathyroid hormone and sclerostin antibody are in the experimental phase.➤ Prior to proceeding with operative intervention for fractures, it is necessary to consider the additional risk posed by diabetes, which must be taken into account when planning the approach, fixation, and postoperative management in this population.

A Dual Peptide Sustained-Release System Based on Nanohydroxyapatite/Polyamide 66 Scaffold for Synergistic-Enhancing Diabetic Rats’ Fracture Healing in Osteogenesis and Angiogenesis

“…Among the well-known consequences of DM, its impact on poor fracture healing has drawn increasing attention ( Henderson et al, 2019 ). In this study, we constructed and proposed a dual peptide sustained-release system based on n-HA/PA66 scaffold to enhance diabetic fracture healing.…”

“…Diabetes mellitus (DM), a chronic metabolic disease common worldwide, has profound deleterious effect on fracture healing and bone formation ( Jiao et al, 2015 ; Marin et al, 2018 ; Henderson et al, 2019 ). Diabetic patients with fractures typically show higher rates of delayed healing and non-union than non-diabetic patients, resulting in a considerable socioeconomic burden ( Sundararaghavan et al, 2017 ; Gortler et al, 2018 ).…”

Bone turnover and metabolite responses to exercise in people with and without long-duration type 1 diabetes: a case–control study

“… 10 Chronic hyperglycemia results in the formation of advanced glycation end products, which suppress bone formation, increase bone brittleness and impair fracture healing. 46 Long-term hyperglycemia also compromises bone vasculature, resulting in decreased bone remodeling. 1 This results in poor bone mineral density and quality, and a high rate of osteoporotic fractures in an aging type 1 diabetes population.…”

The correlation of HbA1c levels on the healing process of postoperative fractures in diabetes mellitus patients

“…14 Insulin can bind to the receptors of osteoblasts and stimulate anabolism, increasing bone formation through increased levels of IGF-1 and GLUT-4. 15,16…”