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[Osteoporosis and diabetes]
L J Dominguez1, M Muratore, E Quarta
1U.O. di Geriatria, Università degli Studi di Palermo, Italy. mabar@unipa.it
Reumatismo
|January 12, 2005
Summary
Elderly individuals with diabetes face a higher risk of fractures, even with normal bone density. Understanding diabetes
Area of Science:
- Gerontology and Endocrinology
- Metabolic Bone Disease
Background:
- Diabetes mellitus and osteoporosis are prevalent chronic conditions in the aging population.
- Elderly diabetics exhibit an increased incidence of fractures, particularly at the hip, humerus, and foot.
- Type 2 diabetes, common in older adults, is often associated with normal or high bone mineral density (BMD), creating a paradox with elevated fracture risk.
Purpose of the Study:
- To explore the mechanisms linking diabetes mellitus to an increased fracture risk in the elderly.
- To investigate how diabetes impacts bone structure and quality, potentially explaining the fracture risk despite normal or high BMD.
- To identify factors contributing to falls in diabetic elderly, such as visual impairment, neuropathy, and muscle weakness.
Main Methods:
- Review of epidemiological studies on fracture risk in diabetic elderly.
- Analysis of experimental models of diabetes to assess bone structure alterations.
- Examination of proposed pathophysiological mechanisms linking diabetes to bone fragility and falls.
Main Results:
- Type 2 diabetes is frequently associated with normal or elevated BMD but a higher risk of fractures in the elderly.
- Altered bone structure in diabetic models suggests a potential explanation for increased fracture susceptibility.
- Diabetic elderly are more prone to falls due to factors like poor vision, neuropathy, and reduced muscle strength.
Conclusions:
- Diabetes affects bone tissue through multiple pathways, including metabolic, structural, and functional changes.
- Mechanisms include advanced glycosylation end products, altered IGF-1 levels, hypercalciuria, renal impairment, microangiopathy, and chronic inflammation.
- A comprehensive understanding of these mechanisms is crucial for developing effective fracture prevention strategies in the aging diabetic population.