Type 2 diabetes and the skeleton: new insights into sweet bones

Shanbhogue, Vikram Vinod; Mitchell, Deborah M.; Rosen, Clifford J.; Bouxsein, Mary L.

doi:10.1016/s2213-8587(15)00283-1

Cited by 194 publications

(186 citation statements)

References 128 publications

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“…Previous reports have been consistent, and reported lower levels of BTM in subjects with T2DM compared to nondiabetic subjects [6,16,21,39]. In insulin resistant [40], obese [17], and healthy subjects [15], glucose-loading is reported to exhibit a suppressive effect on BTM.…”

Section: Discussionmentioning

confidence: 52%

“…Thus the partial volume effect is taken into account by including porosity in voxels containing both void volume and bone matrix, regardless of the pore size [23,24]. Studies using threshold-based methods for assessment of cortical porosity present lower values of porosity (between 1% and 15%) because of quantifying only porosity of the compact-appearing cortex and only pores above 100 µm in diameter [6,24].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with T2DM tend to have higher body mass index (BMI) and areal bone mineral density (aBMD), and would therefore be expected to exhibit reduced risk of fracture. Despite normal or increased aBMD they show increased risk of any fragility fracture [5][6][7][8]. T2DM itself is a modest risk factor for fracture, however, given the large number of individuals with this disease, fracture remains a major clinical concern [9].…”

Section: Introductionmentioning

confidence: 99%

“…The reasons for the increased risk for fracture in T2DM patients are not clear [6,10]. Increased cortical porosity of distal radius or distal tibia has been invoked as one possible factor [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Studies using HR-pQCT to quantify porosity present low values of porosity ranging from 1% to 15% because of quantifying only porosity of the compact cortex and only pores over 100 µm [11][12][13]16], although 60% of cortical pores are under 100 µm in diameter [6,[23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Osima

Kral

Borgen

et al. 2017

Bone

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Increased cortical porosity has been suggested as a possible factor increasing fracture propensity in patients with type 2 diabetes mellitus (T2DM). This is a paradox because cortical porosity is generally associated with high bone turnover, while bone turnover is reduced in patients with T2DM. We therefore wanted to test the hypothesis that women with T2DM have lower bone turnover markers (BTM) and lower cortical porosity than those without diabetes, and that higher serum glucose and body mass index (BMI) are associated with lower BTM, and with lower cortical porosity. Increasing glucose and BMI were associated with lower bone turnover suggesting that reduced intracortical and endocortical remodeling leads to reduced porosity and thicker cortices. Using low-resolution clinical CT, cortical porosity was lower in women with T2DM compared to 3 women without diabetes. This indicates that other changes in bone qualities, not increased cortical porosity, are likely to explain the increased fracture propensity in patients with T2DM.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Osima

Kral

Borgen

et al. 2017

Bone

View full text Add to dashboard Cite

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Sodium-Glucose Cotransporter 2 Inhibitors vs Incretin-Based Drugs and Risk of Fractures for Type 2 Diabetes

Ko,

Bea,

Jeong

et al. 2023

JAMA Netw Open

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ImportancePostmenopausal individuals with type 2 diabetes are susceptible to fractures due to the interaction of elevated blood glucose levels and a deficiency of the hormone estrogen. Despite continued concerns of fracture risks associated with sodium-glucose cotransporter 2 inhibitors (SGLT2i), existing evidence in this high-risk population is lacking.ObjectiveTo assess the risk of fractures associated with SGLT2i vs incretin-based drugs of dipeptidyl-peptidase 4 inhibitors (DPP4i) and glucagon-like peptide 1 receptor agonists (GLP1RA), separately, in postmenopausal individuals with type 2 diabetes.Design, Setting, and ParticipantsThis active-comparator, new-user cohort study used nationwide claims data of Korea and took place from January 1, 2013, to December 31, 2020. Postmenopausal individuals (aged ≥45 years) with type 2 diabetes were included.ExposuresNew users of SGLT2i or comparator drugs.Main Outcomes and MeasuresThe primary outcome was overall fractures, comprising vertebral, hip, humerus, and distal radius fractures. Patients were followed up from the day after drug initiation until the earliest of outcome occurrence, drug discontinuation (90-day grace period) or switch, death, or end of the study period. After propensity score fine stratification, hazard ratios (HRs) with 95% CIs were estimated using weighted Cox models.ResultsAmong 37 530 (mean [SD] age, 60.6 [9.7] years) and 332 004 (mean [SD] age, 60.6 [9.9] years) new users of SGLT2i and DPP4i, respectively, a lower rate of incident overall fractures was presented with SGLT2i vs DPP4i (weighted HR, 0.78; 95% CI, 0.72-0.84). Among 111 835 (mean [SD] age, 61.4 [9.8] years) and 8177 (mean [SD] age, 61.1 [10.3] years) new users of SGLT2i and GLP1RA, respectively, no association with an increased risk of overall fractures was presented with SGLT2i vs GLP1RA (weighted HR, 0.92; 95% CI, 0.68-1.24). Results from several subgroup and sensitivity analyses presented consistent results from main analysis.Conclusions and relevanceThis population-based cohort study suggests that SGLT2i was not associated with an increased rate of incident fractures compared with DPP4i and GLP1RA, separately, among postmenopausal individuals with type 2 diabetes.

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The utility of dried blood spot measurement of bone turnover markers in biological anthropology

Devlin

Eick

Snodgrass

2022

American J Hum Biol

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Objectives: Bone is a dynamic organ under continual turnover influenced by life history stage, energy dynamics, diet, climate, and disease. Bone turnover data have enormous potential in biological anthropology for testing evolutionary and biocultural hypotheses, yet few studies have integrated these biomarkers. In the present article we systematically review the current availability, future viability, and applicability of measuring bone turnover markers (BTMs) in dried blood spot (DBS) samples obtained from finger prick whole blood.Methods: Our review considers clinical and public health relevance, biomarker stability in DBS, assay availability, and cost. We consider biomarkers of bone formation such as osteocalcin (bone matrix protein), PINP (N-terminal propeptide of type I collagen), and alkaline phosphatase (osteoblast enzyme), as well as biomarkers of bone resorption such as CTX (marker of collagen breakdown) and TRACP5b (tartrate-resistant acid phosphatase 5b; osteoclast enzyme). Results: Two BTMs have been validated for DBS: osteocalcin (formation) and TRACP5b (resorption). Prime candidates for future development are CTX and PINP, the formation and resorption markers used for clinical monitoring of response to osteoporosis treatment. Conclusion: BTMs are a field-friendly technique for longitudinal monitoring of skeletal biology during growth, reproduction and aging, combining minimized risk to study participants with maximized ease of sample storage and transport. This combination allows new insights into the effects of energy availability, disease, and physical activity level on bone, and questions about bone gain and loss across life history and in response to environmental factors; these issues are important in human biology, paleoanthropology, bioarchaeology, and forensic anthropology.

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Type 2 diabetes and the skeleton: new insights into sweet bones

Cited by 194 publications

References 128 publications

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Sodium-Glucose Cotransporter 2 Inhibitors vs Incretin-Based Drugs and Risk of Fractures for Type 2 Diabetes

The utility of dried blood spot measurement of bone turnover markers in biological anthropology

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