Skeletal fragility in diabetes

Abstract

Fracture risk is heightened in patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D). Although bone mineral density by dual-energy X-ray absorptiometry is decreased in T1D, it is paradoxically increased with T2D. To predict fracture risk, the Fracture Risk Assessment Tool (FRAX) can be used in diabetes patients, albeit with refinement. Skeletal abnormalities in diabetes include alterations in microarchitecture in T1D and T2D as well as compromised impact microindentation in T2D. Changes in bone microvasculature, advanced glycation end product accumulation, and bone formation may underlie these findings. When fractures occur in T1D and T2D, consequences are worse than in nondiabetic patients with regard to both morbidity and mortality. With regard to treatment, antiresorptive osteoporosis therapies appear to be effective in the setting of diabetes.

Metformin as an add‐on to insulin improves periodontal response during orthodontic tooth movement in type 1 diabetic rats

“…In contrast, a lower rate of tooth displacement and alveolar bone turnover in T1D rats without treatment was reported. These studies do not agree with the substantial evidence linking T1D to osteopenia, osteoporosis, and related cellular and molecular mechanisms, or with studies showing a higher rate of tooth displacement and root resorption in T1D individuals . Therefore, our results suggest that T1D induces fragile bone that cannot support light forces that in turn become too excessive for the periodontal structures leading to breakdown and a different OTM pattern.…”

“…The I‐T1D group showed an OTM rate and vertical displacement similar to T1D but with major preservation of periodontal tissues. Insulin usage in type one diabetics is mandatory, however, they still show moderately low bone mineral density, which may lead to an increased amount of tooth movement. This is explained by the slight hyperglycemia in insulin treated T1D individuals that affects bone structure, strength and quality .…”

“…Insulin is an anabolic agent for bone . A lack of insulin leads to an impaired osteoblast function giving rise to a low bone‐turnover state, which results in a decreased peak bone mass during puberty and a reduced bone mineral density during adult life . However, the use of insulin therapy alone cannot restore bone quality and strength .…”

Evaluation of Bone Turnover in Patients With Type 1 Diabetes Mellitus

“…Similar results were obtained in number of other authors' studies [4,6]. The propensity to low-traumatic fractures in diabetes is associated with changes in the quality of the organic component of bone tissue, under the influence of glycosylation processes of proteins acting on the metabolism of bone tissue and its strength, changing the processes of osteoblastogenesis and osteoclastogenesis [9,10].…”

Management of fracture risk in patients with diabetes—Chinese Expert Consensus

“…Fracture risk management in type 1 diabetes (T1D) should not be neglected either; this is not simply because T1D patients have an increased risk of fractures, but because this risk begins as early as during adolescence …”