Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus

Abstract

The risk of fracture is increased in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, in contrast to the former, patients with T2DM usually possess higher bone mineral density. Thus, there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes. Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk. Moreover, some antidiabetic medications further enhance the fragility of the bone. On the other hand, antiosteoporosis medications can affect the glucose homeostasis in these patients. It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk. Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature. With the advancement in imaging technology, newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes. The purpose of this review is to explore the pathophysiology behind poor bone health in diabetic patients. Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.

Chondroitin Sulfate Alleviates Diabetic Osteoporosis and Repairs Bone Microstructure via Anti-Oxidation, Anti-Inflammation, and Regulating Bone Metabolism

“…DOP is closely related to oxidative stress. Hyperglycemia induced reactive oxygen species (ROS) production in vivo and hindered the proliferation and differentiation of osteoblasts (21)(22)(23). It has been confirmed that a sharp increase in the level of ROS induces death of osteoblasts, resulting in bone structure damage and BMD reduction (24).…”

Prediabetes and osteoporotic fracture risk: A meta‐analysis of prospective cohort studies

“…Accumulating evidence from epidemiological stuides has indicated that diabetes confers a higher risk of osteoporotic fracture 1,2 . A recent meta‐analysis that included 22 cohort studies showed that type 1 and type 2 diabetes mellitus (T1DM and T2DM) are both associated with a higher risk of fracture, particularly T1DM, compared with normoglycemia 3 .…”

Characterizing Bone Phenotypes Related to Skeletal Fragility Using Advanced Medical Imaging

“…In theory, gauging fracture risk within a specific disease should be more precise than in the broader population, given it is driven by a specific pathology. Yet, in many cases, bone traits among individuals within a disease are as highly variable as in healthy cohorts, confounding our ability to assess who is at risk of fracture and limiting the ability to develop tailored interventions [ 60 – 62 ]. The heterogeneity in bone traits within a disease may in part be attributed to the interplay between the disease and an individual’s bone phenotype, termed the “disease-phenotype” interaction.…”