TY - JOUR
T1 - Mechanisms of diabetes mellitus-induced bone fragility
AU - Napoli, Nicola
AU - Chandran, Manju
AU - Pierroz, Dominique D.
AU - Abrahamsen, Bo
AU - Schwartz, Ann V.
AU - Ferrari, Serge L.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - The risk of fragility fractures is increased in patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Although BMD is decreased in T1DM, BMD in T2DM is often normal or even slightly elevated compared with an age-matched control population. However, in both T1DM and T2DM, bone turnover is decreased and the bone material properties and microstructure of bone are altered; the latter particularly so when microvascular complications are present. The pathophysiological mechanisms underlying bone fragility in diabetes mellitus are complex, and include hyperglycaemia, oxidative stress and the accumulation of advanced glycation endproducts that compromise collagen properties, increase marrow adiposity, release inflammatory factors and adipokines from visceral fat, and potentially alter the function of osteocytes. Additional factors including treatment-induced hypoglycaemia, certain antidiabetic medications with a direct effect on bone and mineral metabolism (such as thiazolidinediones), as well as an increased propensity for falls, all contribute to the increased fracture risk in patients with diabetes mellitus.
AB - The risk of fragility fractures is increased in patients with either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Although BMD is decreased in T1DM, BMD in T2DM is often normal or even slightly elevated compared with an age-matched control population. However, in both T1DM and T2DM, bone turnover is decreased and the bone material properties and microstructure of bone are altered; the latter particularly so when microvascular complications are present. The pathophysiological mechanisms underlying bone fragility in diabetes mellitus are complex, and include hyperglycaemia, oxidative stress and the accumulation of advanced glycation endproducts that compromise collagen properties, increase marrow adiposity, release inflammatory factors and adipokines from visceral fat, and potentially alter the function of osteocytes. Additional factors including treatment-induced hypoglycaemia, certain antidiabetic medications with a direct effect on bone and mineral metabolism (such as thiazolidinediones), as well as an increased propensity for falls, all contribute to the increased fracture risk in patients with diabetes mellitus.
UR - http://www.scopus.com/inward/record.url?scp=84988546109&partnerID=8YFLogxK
U2 - 10.1038/nrendo.2016.153
DO - 10.1038/nrendo.2016.153
M3 - Review
C2 - 27658727
AN - SCOPUS:84988546109
SN - 1759-5029
VL - 13
SP - 208
EP - 219
JO - Nature Reviews Endocrinology
JF - Nature Reviews Endocrinology
IS - 4
ER -