Type 2 Diabetes Mellitus and Vertebral Fracture Risk

Abstract Purpose of Review The purpose of this review is to summarize the recently published evidence concerning vertebral fracture risk in individuals with diabetes mellitus. Recent Findings Vertebral fracture risk is increased in individuals with T2DM. The presence of vertebral fractures in T2DM is associated with increased non-vertebral fracture risk and mortality. TBS could be helpful to estimate vertebral fracture risk in individuals with T2DM. An increased amount of bone marrow fat has been implicated in bone fragility in T2DM. Results from two recent studies show that both teriparatide and denosumab are effective in reducing vertebral fracture risk also in individuals with T2DM. Summary Individuals with T2DM could benefit from systematic screening in the clinic for presence of vertebral fractures.

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Indications of Increased Vertebral Fracture Risk in Patients With Type 2 Diabetes

Journal of Bone and Mineral Research ◽

10.1002/jbmr.3323 ◽

2017 ◽

Vol 33 (1) ◽

pp. 182-182 ◽

Cited By ~ 2

Author(s):

Jakob Starup-Linde ◽

Katrine Hygum ◽

Torben Harsløf ◽

Bente Lomholt Langdahl

Keyword(s):

Type 2 Diabetes ◽

Vertebral Fracture ◽

Fracture Risk ◽

Vertebral Fracture Risk

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Reply to: Indications of Increased Vertebral Fracture Risk in Patients With Type 2 Diabetes

Journal of Bone and Mineral Research ◽

10.1002/jbmr.3322 ◽

2018 ◽

Vol 33 (1) ◽

pp. 183-183 ◽

Cited By ~ 1

Author(s):

Nicola Napoli ◽

Ann V Schwartz ◽

Dennis M Black ◽

Keyword(s):

Type 2 Diabetes ◽

Vertebral Fracture ◽

Fracture Risk ◽

Vertebral Fracture Risk

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Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility

Journal of Diabetes Research ◽

10.1155/2020/7608964 ◽

2020 ◽

Vol 2020 ◽

pp. 1-18 ◽

Cited By ~ 4

Author(s):

C. Eller-Vainicher ◽

E. Cairoli ◽

G. Grassi ◽

F. Grassi ◽

A. Catalano ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Fracture Risk ◽

Bone Quality ◽

Fragility Fractures ◽

Bone Fragility ◽

Pathophysiological Mechanisms ◽

Increased Risk

Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of bone fragility fractures compared to nondiabetic subjects. This increased fracture risk may occur despite normal or even increased values of bone mineral density (BMD), and poor bone quality is suggested to contribute to skeletal fragility in this population. These concepts explain why the only evaluation of BMD could not be considered an adequate tool for evaluating the risk of fracture in the individual T2DM patient. Unfortunately, nowadays, the bone quality could not be reliably evaluated in the routine clinical practice. On the other hand, getting further insight on the pathogenesis of T2DM-related bone fragility could consent to ameliorate both the detection of the patients at risk for fracture and their appropriate treatment. The pathophysiological mechanisms underlying the increased risk of fragility fractures in a T2DM population are complex. Indeed, in T2DM, bone health is negatively affected by several factors, such as inflammatory cytokines, muscle-derived hormones, incretins, hydrogen sulfide (H2S) production and cortisol secretion, peripheral activation, and sensitivity. All these factors may alter bone formation and resorption, collagen formation, and bone marrow adiposity, ultimately leading to reduced bone strength. Additional factors such as hypoglycemia and the consequent increased propensity for falls and the direct effects on bone and mineral metabolism of certain antidiabetic medications may contribute to the increased fracture risk in this population. The purpose of this review is to summarize the literature evidence that faces the pathophysiological mechanisms underlying bone fragility in T2DM patients.

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Existing severe osteoporotic vertebral fractures in elderly Chinese males were only weakly associated with higher further vertebral fracture risk at year-4 follow-up

Osteoporosis International ◽

10.1007/s00198-020-05480-3 ◽

2020 ◽

Vol 31 (8) ◽

pp. 1593-1594 ◽

Cited By ~ 1

Author(s):

Y.X.J. Wáng ◽

N. Che-Nordin ◽

J.C.S. Leung ◽

T.C.Y. Kwok

Keyword(s):

Vertebral Fracture ◽

Fracture Risk ◽

Vertebral Fractures ◽

Osteoporotic Vertebral Fractures ◽

Vertebral Fracture Risk ◽

Elderly Chinese

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The incidence of osteoporosis and vertebral fracture in women with postmenopausal type 2 diabetes mellitus and predisposing factors of vertebral fractures

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213702 ◽

2021 ◽

Vol 8 (10) ◽

pp. 1478

Author(s):

Tugcan Alp Kirkizlar ◽

Mehmet Burak Aktuglu

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vertebral Fracture ◽

Peripheral Neuropathy ◽

Vertebral Fractures ◽

Postprandial Blood Glucose ◽

Type 2 Dm ◽

Postmenopausal Period

Background: Type 2 diabetes mellitus (DM) has an increased fracture risk due to loss of bone quality and tendency to falling. The aim of the study was to analyze the incidence of osteoporosis and vertebral fractures (VF) in postmenopausal women with type 2 DM and to define the risk factors of VF in terms of clinical, metabolic characteristics and diabetes related microvascular complications.Methods: The 42 postmenopausal patients with type 2 DM were included to the study in Haseki Training and Research Hospital outpatient clinics.Results: Osteoporosis with regard to lumbar spine (LS) and femur neck (FN) was 8.4%, 19.4%, respectively. Vertebral fracture ratio was 31%. There was no statistical significance between vertebral fracture and osteoporosis. In logistic regression analysis, longer postmenopausal period, higher postprandial blood glucose (PBG), presence of peripheral neuropathy was found associated with vertebral fracture (p=0.04, 0.04, and 0.05, respectively).Conclusions: In this study we suggest to consider the length of postmenopausal period, PBG and peripheral neuropathy for assessing the risk of VF.

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Bazedoxifene Trims Vertebral Fracture Risk in Osteoporosis

Family Practice News ◽

10.1016/s0300-7073(07)71355-5 ◽

2007 ◽

Vol 37 (22) ◽

pp. 14

Author(s):

GREG MUIRHEAD

Keyword(s):

Vertebral Fracture ◽

Fracture Risk ◽

Vertebral Fracture Risk

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Trabecular Bone Score in Thais with or without Type 2 Diabetes

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.11.11245 ◽

2020 ◽

Vol 103 (11) ◽

pp. 1131-1137

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Fracture Risk ◽

Trabecular Bone ◽

Trabecular Bone Score ◽

Mineral Density ◽

Men And Women

Background: When compared to people without type 2 diabetes mellitus (T2DM), people with T2DM have an increase in fracture risk despite having higher bone mineral density (BMD). Many studies in Caucasians demonstrated that trabecular bone score (TBS) is lower in people with T2DM than those without. The utility of TBS as a fracture risk assessment tool in Asians with T2DM is currently unclear. Objective: To compared lumbar spine (LS) BMD and TBS in Thais with or without T2DM and investigate the correlation between TBS and hemoglobin A1c (HbA1c) and diabetes duration in participants with T2DM. Materials and Methods: The present study was a cross-sectional study that included 97 participants with T2DM (37 men and 60 women) and 342 participants without T2DM (174 men and 168 women). LS-BMD and TBS were obtained. Results: Men and women with T2DM were older and had higher body mass index (BMI). Men with T2DM had significant higher LS-BMD (1.051±0.166 versus 0.972±0.125, p=0.009) and non-significant lower TBS (1.333±0.084 versus 1.365±0.096, p=0.055) than those without. Similarly, women with T2DM had significant higher LS-BMD (0.995±0.155 versus 0.949±0.124, p=0.021) and lower TBS (1.292±0.105 versus 1.382±0.096, p<0.001). After adjusting for age and BMI, T2DM predicted higher BMD in men (p<0.001), but not in women (p=0.143). T2DM was not associated with TBS after adjusting for age and BMI in both genders (p=0.403 and p=0.151 in men and women, respectively). TBS did not correlate with HbA1c in both genders. However, TBS was non-significantly associated with diabetes duration in women (p=0.073), but not in men (p=0.639). Conclusion: T2DM significantly predicted higher LS-BMD only in men and was not independently associated with TBS in both genders. These data highlighted that, in T2DM, there was some variation in the clinical usefulness of BMD and TBS in predicting osteoporotic fractures with regard to clinical characteristic of participants. Keywords: Bone mineral density, Type 2 diabetes mellitus, Trabecular bone score

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