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Type 2 diabetes and osteoporosis: Current knowledge

Although bone health is primarily associated with age, recent studies have shown that individuals with diabetes mellitus (DM) have up to 6 times higher incidence of osteoporotic fractures compared to the general population. So far, there is no single entity for this condition, primarily due to the different mechanisms of development in type 1 DM (T1DM) and type 2 DM (T2DM), as well as different mechanisms of osteoporosis development. Diabetes affects bone metabolism by various mechanisms including changes in insulin concentration, insulin-like growth factor-1 (IGF-1), and amylin. Hyperinsulinemia (the predominant characteristic of the T2DM) can stimulate bone formation, whereas in contrast to hypothyroidism (the predominant characteristic of T1DM), both lead to bone density reduction. Chronic hyperglycemia leads to the creation and accumulation of advanced glycation end products (AGEs) in collagen. The aforementioned changes in the bone architecture, decreasing its strength and increasing its fragility. In addition, hyperglycemia leads to glycosuria resulting in hypercalciuria, leads to hypocalcemia, accelerated bone resorption, and thus contributes to osteoporosis. Finally, the microvascular complications of DM result in decreased blood flow to the bone and thus additionally contribute to the onset of osteoporosis. Here, we review the current knowledge in epidemiology, pathophysiology, diagnosis, and treatment of osteoporosis in diabetes.

Type 2 diabetes ; osteoporosis ; diabetoporosis

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