Diabetes and Bone Fragility
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REVIEW
Diabetes and Bone Fragility Camila Romero-Dı´az . Daniela Duarte-Montero . Sebastia´n A. Gutie´rrez-Romero . Carlos O. Mendivil
Received: October 6, 2020 / Accepted: October 29, 2020 Ó The Author(s) 2020
ABSTRACT Diabetes is a highly prevalent disease with complications that impact most bodily systems. However, the impact of diabetes on bone health is frequently ignored or underestimated. Both type 1 (T1D) and type 2 diabetes (T2D) are associated with a higher risk of fractures, albeit through different mechanisms. T1D is characterized by near total insulinopenia, which affects the anabolic tone of bone and results in reduced bone mineral density (BMD). Meanwhile, patients with T2D have normal or high BMD, but carry an increased risk of fractures due to alterations of bone microarchitecture and a local humoral environment that stimulates osteoclast activity. Chronic hyperglycemia induces non-enzymatic glycation of collagen in both types of diabetes. Epidemiological evidence confirms a largely increased fracture risk in T1D and T2D, but also that it can be substantially reduced by opportune monitoring of fracture risk and appropriate
C. Romero-Dı´az D. Duarte-Montero S. A. Gutie´rrez-Romero C. O. Mendivil (&) School of Medicine, Universidad de los Andes, Bogota´, Colombia e-mail: [email protected]; [email protected] C. O. Mendivil Department of Internal Medicine, Endocrinology Section, Fundacio´n Santa Fe de Bogota´, Bogota´, Colombia
treatment of both diabetes itself and osteopenia or osteoporosis if they are present. In this review, we summarize the mechanistic, epidemiological, and clinical evidence that links diabetes and bone fragility, and describe the impact of available diabetes treatments on bone health.
Keywords: Bone; Bones; Denosumab; Diabetes mellitus; Fractures; Osteoporosis
Diabetes Ther
Key Summary Points Both type 1 and type 2 diabetes are associated with bone abnormalities and increased fracture risk, especially at the hip The mechanisms involved in type 1 diabetes involve reduced BMD as a consequence of insufficient anabolic tone from insulin Meanwhile, patients with type 2 diabetes usually have normal/increased BMD but have microarchitectural bone alterations that increase their risk of fracture Fracture risk should be taken into account when selecting antidiabetic medications for a patient Fracture risk should be routinely assessed and addressed in patients with diabetes
DIGITAL FEATURES This article is published with digital features, including a summary slide, to facilitate understanding of the article. To view digital features for this article go to https://doi.org/10.6084/ m9.figshare.13154408.
INTRODUCTION There is a strong interaction between insulin action and bone metabolism [1]. Therefore, both type 1 (T1D) and type 2 diabetes (T2D) are associated with a higher risk of fractures. Nonetheless, the mechanisms of the effects on bone in T1D and T2D may be different and do not necessarily involve a reduction in bone mineral density (BMD) [2]. Several studi
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