Diabetes and bone health: latest evidence and clinical implications

Abstract

As the prevalence of diabetes is increasing worldwide, research on some of the lesser-known effects, including impaired bone health, are gaining a lot of attention. The two most common forms of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). These two differ in their physiology, with T1DM stemming from an inability to produce insulin, and T2DM involving an insufficient response to the insulin that is produced. This review aims to highlight the most current information regarding diabetes as it relates to bone health. It looks at biochemical changes that characterize diabetic bone; notably increased adiposity, altered bone metabolism, and variations in bone mineral density (BMD). Then several hypotheses are analyzed, concerning how these changes may be detrimental to the highly orchestrated processes that are involved in bone formation and turnover, and ultimately result in the distinguishing features of diabetic bone. The review proceeds by explaining the effects of antidiabetes medications on bone health, then highlighting several ways that diabetes can play a part in other clinical treatment outcomes. With diabetes negatively affecting bone health and creating other clinical problems, and its treatment options potentiating these effects, physicians should consider the use of anti-osteoporotic drugs to supplement standard anti-diabetes medications in patients suffering with diabetic bone loss.

Differential Effect of Long-Term Systemic Exposure of TNFα on Health of the Annulus Fibrosus and Nucleus Pulposus of the Intervertebral Disc

“…In addition to the altered systemic cytokine profile, the overexpression of hTNFα resulted in alterations in vertebral bone structure including cortical and trabecular thinning. There is a well‐established link between systemic inflammatory conditions and reduced bone mass for both smoking and diabetes . The state of the neighboring vertebral bone inflammation is pertinent to the discussion of degenerative disc disease: bone marrow inflammation with Modic changes, is highly correlated with painful disc degeneration .…”

“…There is a well-established link between systemic inflammatory conditions and reduced bone mass for both smoking and diabetes. (38,39) The state of the neighboring vertebral bone inflammation is pertinent to the discussion of degenerative disc disease: bone marrow inflammation with Modic changes, is highly correlated with painful disc degeneration. (40,41) However, despite vertebral bone inflammation there were no corresponding changes in disc health.…”

<p>Relationship of Two-Hour Plasma Glucose and Abdominal Visceral Fat with Bone Mineral Density and Bone Mineral Content in Women with Different Glucose Metabolism Status</p>

“…These abnormalities might affect bone metabolism indexes by different mechanisms. 24 This study showed that FN BMD (0.83±0.13), LS BMD (1.03±0.18) and BMC (1.92±4.16) in T2DM group were lower than those of FN BMD (0.91±0.13), LS BMD (1.15±0.16), and BMC (2.12±4.29) in NGT group. And the BMC was also lower in T2DM group than pre-DM group (2.28±4.15).…”

Evidence for Gender-Specific Bone Loss Mechanisms in Periprosthetic Osteolysis

“…While none of the patients in this study were reported as having clinical signs of metallosis or metal hypersensitivity, factors such as BMI, drug status, levels of physical activity and underlying comorbidities were not taken into account. Conditions including diabetes mellitus [39], a history of smoking [40] and obesity [41] have all been shown to affect bone health, and thus could potentially contribute to the changes observed. A larger cohort of patients with sufficient statistical power to allow multivariate analysis of all potentially contributing factors would help elucidate the influence of gender on the possible mechanisms of bone loss.…”