Fragility fractures and bone remodeling in type 2 diabetes mellitus

Abstract

Fracture risk is significantly increased in both type 1 and type 2 diabetes and individuals with diabetes experience worse fracture outcomes compared to normoglycemic individuals. Patients with T1DM have decreased bone mineral density (BMD), whereas patients with T2DM demonstrate increased BMD compared to healthy control. The latest studies show increased incidence of low-traumatic fractures in patients with T2DM instead of high bone mineral density (BMD). The risk of osteoporotic fractures in patients with T2DM can be explained by disease complications and increased risk of falls and consequent trauma. However, the most important cause of bone fragility in T2DM is the deterioration in bone microarchitecture, the mechanism of which is not completely understood. High BMD in patients with T2DM does not allow us to use dual-energy X-ray-absorptiometry as a gold standard test for diagnosticsof osteoporosis. Consequently,new risk factors and diagnostic algorithm as well as treatment strategy should be developed for patients with T2DM. In addition to this, some researchers considered that the group of T2DM is geterogenous and physicians might face patients with osteoporosis and mild diabetes that add very little to bone fragility; patients with osteoporosis and moderate or severe diabetes which also affects bone tissue diabetoosteoporosis; and patients without osteoporosis but severe diabetes which cause bone tissue deterioration with the development of diabetic bone disease. New diagnostic tools and algorithm and new experimental research are needed for better understanding bone deterioration in patients with T2DM. This review summarizes our current knowledge on fracture rate, risk factors for fractures and causes of bone deterioration in subjects with T2DM.

Morphological Characteristics and Correction of Long Tubular Bone Regeneration under Chronic Hyperglycemia Influence

“…In vitro Analytical Cellular Pathology studies have identified decreasing of newly formed tissue ossification and impaired cartilage formation due to insulin deficiency. Researchers have found that collagen synthesis level in the fracture zone of DM rats decreased by 50-55%, which led to deterioration of mechanical properties of newly formed tissue [20]. In our study, we found impaired collagen structuring into osteoid beams and uneven formation and placement of cartilage in bone regenerates of animals with CH.…”

Features of bone metabolism in diabetes mellitus

“…В коллагене КПГ приводят к образо-ванию неферментативных поперечных сшивок. Увели-чение числа поперечных сшивок коллагена уменьшает пластичность матрицы, и кость разрушается при дефор-мации [5]. Считается, что КПГ в настоящее время играют решающую роль в развитии диабетических осложнений, потому что гипергликемия и окислительный стресс уско-ряют формирование КПГ [4].…”