The present review examined the effects of diabetes on the occurrence of osteoporosis (reduced bone mineral density-BMD) and fractures.
Type 1 diabetes (T1DM) and type 2 diabetes (T2DM) are associated with a high risk of osteoporotic fractures but have different effects on the BMD. While in T1DM bone formation is damaged in T2DM the BMD is increased but the bone quality is reduced.
Several studies have shown that T1DM is associated with a higher risk of hip and spine fracture, whereas T2DM has a tendency toward wrist fractures. For patients with T1DM the risk of hip fracture is 12 times higher if they have diabetic nephropathy (diabetes-related kidney damage). Other diabetes-related risk factors include diabetic neuropathy (damage to nerves) and the use of Glitazones (Avandia, Actos) in post-menopausal women, or Insulin for patients with T2DM. Another important risk factor among patients with T2DM is a disease duration of at least 10 years.
In patients with advanced diabetes, falls represent an important risk factor, especially for hip fractures. Altered vision due to diabetic retinopathy (damage to the retina), walking disorders and vitamin D deficiency can lead to falls. This can be managed by strengthening the muscles, preventing diabetes-associated complications and using vitamin D and calcium supplements.
The mechanism through which diabetes leads to low bone mass and fractures is not completely understood. Studies made on this subject mention as probable causes: alterations in the bone cell biology (i.e. impairment of bone formation), lack of insulin (leads to low bone mass) and increased blood sugar levels.
Diabetes can lead to osteoporotic fractures so it is very important to identify patients with diabetes and osteoporosis before they have fractures. The best treatment is to keep a normal blood sugar level and an aggressive prevention of diabetic complications. Also falls should be prevented and Glitazones should be avoided. The treatment of osteoporosis is similar in patients with or without diabetes. After correcting calcium and vitamin D levels, most osteoporosis drugs can be used, adjusted individually.
Published By :
Nature Reviews Endocrinology
Jan 17, 2012
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