Diabetes and bone health: latest evidence and clinical implications

As the prevalence of diabetes is increasing worldwide, research on some of the lesser-known effects, including impaired bone health, are gaining a lot of attention. The two most common forms of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). These two differ in their physiology, with T1DM stemming from an inability to produce insulin, and T2DM involving an insufficient response to the insulin that is produced. This review aims to highlight the most current information regarding diabetes as it relates to bone health. It looks at biochemical changes that characterize diabetic bone; notably increased adiposity, altered bone metabolism, and variations in bone mineral density (BMD). Then several hypotheses are analyzed, concerning how these changes may be detrimental to the highly orchestrated processes that are involved in bone formation and turnover, and ultimately result in the distinguishing features of diabetic bone. The review proceeds by explaining the effects of antidiabetes medications on bone health, then highlighting several ways that diabetes can play a part in other clinical treatment outcomes. With diabetes negatively affecting bone health and creating other clinical problems, and its treatment options potentiating these effects, physicians should consider the use of anti-osteoporotic drugs to supplement standard anti-diabetes medications in patients suffering with diabetic bone loss.

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Bone mineral density predictors in long-standing type 1 and type 2 diabetes mellitus

BMC Endocrine Disorders ◽

10.1186/s12902-021-00815-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefana Catalina Bilha ◽

Letitia Leustean ◽

Cristina Preda ◽

Dumitru D. Branisteanu ◽

Laura Mihalache ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Lumbar Spine ◽

Femoral Neck ◽

Bone Mineral ◽

Mineral Density ◽

Cross Sectional ◽

The Impact

Abstract Background Despite the increased fracture risk, bone mineral density (BMD) is variable in type 1 (T1D) and type 2 (T2D) diabetes mellitus. We aimed at comparing independent BMD predictors in T1D, T2D and control subjects, respectively. Methods Cross-sectional case-control study enrolling 30 T1D, 39 T2D and 69 age, sex and body mass index (BMI) – matched controls that underwent clinical examination, dual-energy X-ray absorptiometry (BMD at the lumbar spine and femoral neck) and serum determination of HbA1c and parameters of calcium and phosphate metabolism. Results T2D patients had similar BMD compared to T1D individuals (after adjusting for age, BMI and disease duration) and to matched controls, respectively. In multiple regression analysis, diabetes duration – but not HbA1c- negatively predicted femoral neck BMD in T1D (β= -0.39, p = 0.014), while BMI was a positive predictor for lumbar spine (β = 0.46, p = 0.006) and femoral neck BMD (β = 0.44, p = 0.007) in T2D, besides gender influence. Age negatively predicted BMD in controls, but not in patients with diabetes. Conclusions Long-standing diabetes and female gender particularly increase the risk for low bone mass in T1D. An increased body weight partially hinders BMD loss in T2D. The impact of age appears to be surpassed by that of other bone regulating factors in both T1D and T2D patients.

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The TUDID Study – Background and Design of a Prospective Cohort

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1221-9618 ◽

2020 ◽

Author(s):

Benjamin Assad Jaghutriz ◽

Robert Wagner ◽

Stephanie Kullmann ◽

Louise Fritsche ◽

Sabine S. Eckstein ◽

...

Keyword(s):

Diabetes Mellitus ◽

Laboratory Tests ◽

Diabetes Complications ◽

Treatment Options ◽

University Hospital ◽

Tailored Treatment ◽

The Individual

AbstractPrevalence of both type 1 and type 2 diabetes mellitus is growing worldwide and one major cause for morbidity and mortality. However, not every patient develops diabetes-related complications, but causes for the individual susceptibility are still not fully understood. As a platform to address this, we initiated the TUDID (TUebingen DIabetes Database) study, a prospective, monocentric, observational study that includes adults with diabetes mellitus who are treated in the inpatient clinic of a University Hospital in southern Germany. Besides a thorough clinical examination and extensive laboratory tests (with integrated biobanking), major study focuses are the kidneys, the eyes, the vasculature as well as cognition and mood where standardized investigations for early stages for diabetes complications are performed. Analyses of the data generated by this precise characterization of diabetes-related complications will contribute to our understanding of the development and course of such complications, and thus facilitate the implementation of tailored treatment options that can reduce the risk and severity of diabetes-related complications.

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Diabetes mellitus and osteoporosis: pathogenetic relationship and current principles of treatment

Medical Council ◽

10.21518/2079-701x-2021-7-96-107 ◽

2021 ◽

pp. 96-107

Author(s):

T. Y. Demidova ◽

V. M. Plakhotnyaya

Keyword(s):

Diabetes Mellitus ◽

Bone Matrix ◽

Wnt Signaling Pathway ◽

Bone Fragility ◽

Current Data ◽

Mineral Density ◽

Increased Risk ◽

Dm Type 2

Diabetes mellitus (DM) is a well known risk factor for osteoporosis and an increased risk of fractures. A lot of data has been published about the relationship between diabetes and bone health. DM type 1 and DM type 2 have different effects on bone mineral density (BMD). The central link in pathogenesis of bone fragility in patients with DM type 1 is a violation of the activity and gifferentiation of osteoblasts. On the contrary, hyperinsulinemia in DM type 2 activates the division and gifferentiation of osteoblasts and contributes to an increase in BMD. However, Higher BMD values in patients with DM type 2 are combined with slowdown in bone metabolism. As the result, high-quality bone remodeling does not occur. And bone strength decreases despite the high BMD. Despite the differences, DM type 1 and DM type 2 have common pathogenic pathways, that lead to increased bone fragility. For example, non-enzymatic glycation of bone matrix collagen and increase in concentration of sclerostin, which blocks the Wnt signaling pathway. In this review, we will analyze current data about epidemiology and pathogenesis of osteoporosis in DM and discuss the practical issues of the clinic, diagnosis, stratification of fracture risk and treatment. Special attention will be paid to the effects of glucose-lowering and anti-osteoporotic drugs on bone tissue.

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Evaluation of Bone Health among Type 2 Diabetes Mellitus Patients

Journal of Pharmacy and Nutrition Sciences ◽

10.29169/1927-5951.2021.11.16 ◽

2021 ◽

Vol 11 ◽

pp. 134-143

Author(s):

Shaymaa Abdulameer ◽

Mohanad Sahib ◽

Syed Azhar Syed Sulaiman

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Clinical Data ◽

Bone Health ◽

Density Measurement ◽

Health Belief ◽

Preventive Strategy ◽

Mineral Density

Background: Type 2 diabetes mellitus (T2DM) and osteoporosis remain one of the major public health problems worldwide with a considerable burden on society. Health belief toward osteoporosis is fundamental to all osteoporosis management programs and is often a pre-requisite for initiating desired behavioral changes. The aim of this study was to assess: the level of the Malay version of the Osteoporosis Health Belief Scale (OHBS-M) among T2DM patients; the relation of socio-demographic characteristics, clinical data with OHBS-M level and the correlation between OHBS-M score and T-score. Methods: An observational, cross-sectional study design was conducted among T2DM patients. Socio-demographic and clinical data were collected using a convenient sampling method. All T2DM patients underwent the bone mineral density measurement using a quantitative ultrasound scan (QUS). Results: The result showed the average age of the participants was 62.67± 9.24 years. The study findings revealed that the average total score of OHBS-M 143.08±24.22 (median 141.50) with 85.60% of T2DM patients had a low level of osteoporosis health belief. Moreover, a significant correlation was found between the QUS T-scores and osteoporosis health beliefs. Conclusions: The study findings revealed that the assessment of T2DM patients’ bone health and health belief toward osteoporosis is crucial to improve an osteoporosis preventive strategy for high-risk populations.

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Bone mineral density in patients with type 1 and type 2 diabetes mellitus

Haydarpasa Numune Training and Research Hospital Medical Journal ◽

10.14744/hnhj.2017.52824 ◽

2017 ◽

Author(s):

Pınar Akpınar

Keyword(s):

Diabetes Mellitus ◽

Bone Mineral Density ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Bone Mineral ◽

Mineral Density

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Effect of Diabetes Mellitus and Anti-Diabetic Drugs on Bone Health-A Review

Journal of Bioresource Management ◽

10.35691/jbm.1202.0187 ◽

2021 ◽

Vol 8 (2) ◽

pp. 131-148

Author(s):

Farah Deeba ◽

Sidra Younis ◽

Nida Qureshi ◽

Tahmina Mustafa ◽

Nadia Iqbal ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bone Mass ◽

Bone Fracture ◽

Bone Health ◽

Diabetic Patients ◽

Mineral Density ◽

Type 2 Diabetic Patients ◽

Increased Risk

Osteoporosis and diabetes mellitus (DM) are widespread diseases and have a significant health burden. Type-1 diabetes mellitus (T1DM) and Type-2 diabetes mellitus (T2DM) are associated with an increased bone fracture. In T1DM, the increased risk of bone fracture is associated with low bone mass. In patients with T2DM, the risk of fracture of the bone is increased due to low quality of bone, despite increased bone mineral density (BMD). In type 2 diabetic patients, bone fragility depends on the quality of bone instead of a reduction in bone mass. Thiazolidinediones (TZD) cause differentiation of adipocytes and inhibit differentiation of osteoblast and bone marrow stromal stem cells (BMSC). In this review, we have described the effect of anti-diabetic drugs and diabetes mellitus on bone health and our finding shows that sulfonylureas and metformin have no negative effect on bone health and protect bones against fractures.

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Chronic kidney disease in patients with diabetes mellitus

Endocrine Connections ◽

10.1530/ec-21-0097 ◽

2021 ◽

Vol 10 (5) ◽

pp. R151-R159

Author(s):

Espen Nordheim ◽

Trond Geir Jenssen

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Treatment Options ◽

Specific Treatment ◽

Patients With Diabetes ◽

Concomitant Condition

Chronic kidney disease is a common complication and concomitant condition of diabetes mellitus. The treatment of patients with diabetes and chronic kidney disease, including intensive control of blood sugar and blood pressure, has been very similar for type 1 and type 2 diabetes patients. New therapeutic targets have shown promising results and may lead to more specific treatment options for patients with type 1 and type 2 diabetes.

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