Diabetes, Biochemical Markers of Bone Turnover, Diabetes Control, and Bone

Abstract

Diabetes mellitus is known to have late complications including micro vascular and macro vascular disease. This review focuses on another possible area of complication regarding diabetes; bone. Diabetes may affect bone via bone structure, bone density, and biochemical markers of bone turnover. The aim of the present review is to examine in vivo from humans on biochemical markers of bone turnover in diabetics compared to non-diabetics. Furthermore, the effect of glycemic control on bone markers and the similarities and differences of type 1- and type 2-diabetics regarding bone markers will be evaluated. A systematic literature search was conducted using PubMed, Embase, Cinahl, and SveMed+ with the search terms: “Diabetes mellitus,” “Diabetes mellitus type 1,” “Insulin dependent diabetes mellitus,” “Diabetes mellitus type 2,” “Non-insulin dependent diabetes mellitus,” “Bone,” “Bone and Bones,” “Bone diseases,” “Bone turnover,” “Hemoglobin A Glycosylated,” and “HbA1C.” After removing duplicates from this search 1,188 records were screened by title and abstract and 75 records were assessed by full text for inclusion in the review. In the end 43 records were chosen. Bone formation and resorption markers are investigated as well as bone regulating systems. T1D is found to have lower osteocalcin and CTX, while osteocalcin and tartrate-resistant acid are found to be lower in T2D, and sclerostin is increased and collagen turnover markers altered. Other bone turnover markers do not seem to be altered in T1D or T2D. A major problem is the lack of histomorphometric studies in humans linking changes in turnover markers to actual changes in bone turnover and further research is needed to strengthen this link.

Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease

“…However, in line with most previous studies (13,14,15), we found (for MVDC and MVDK patients alike) significantly lower biochemical markers of bone formation and resorption in comparison with healthy controls. This suggests that alterations in bone turnover are unlikely to be the explanation for the structural differences between the groups.…”

“…The discrepancies in the results may be due to the limited number of patients (n!30) and heterogeneity in patient characteristics, particularly duration of diabetes, level of glycemic control and the presence of diabetic microvascular complications. As most histomorphometric and biochemical studies indicate that T2D is associated with low bone turnover (13,14,15), it is surprising that an increase in cortical porosity was the most consistent abnormality reported in the HR-pQCT studies (8,11,12). It is not known if this is the result of an additional insult such as the manifestation of microvascular disease (MVD), which has been linked to an increase in fracture risk in patients with T2D (16).…”

Serum sclerostin in hepatitis C virus infected patients

“…[16] The possibility exists that sclerostin is related to insulin resistance, adding a new link in the recently described connection between bone-secreted proteins, such as osteocalcin or sclerostin, beta cell function, adipokines, and insulin sensivity. [17] Liver steatosis constitutes one of the outstanding manifestations of insulin resistance in hepatitis C virus (HCV) infection. HCV by itself -especially genotype 3-may lead to liver steatosis, but obesity and concomitant alcohol abuse are the main factors involved.…”

Relationship between glycemic control and OPG gene polymorphisms with lower bone mineral density in patients with type 1 Diabetes mellitus

“…More than 50% of patients with T1DM have bone loss compared to healthy age-matched subjects (Muñoz-Torres et al, 1996;Kemink et al, 2000) markers of bone formation plasma insulin-like growth factor I (IGF-I), and a variety of bone-related changes are known to be influenced by hyperglycemia such as femoral neck geometry, microarchitecture and biomechanical markers of bone turnover (Starup-Linde, 2013;Bortolin et al, 2015;. However, the association between T1DM and bone mineral density (BMD) is controversial.…”