[Therapeutic approaches for diabetic osteopahty]

Although the clinical manifestations of diabetic osteopahty are not fully elucidated, diabetes may affect bone remodeling by various mechanisms, including deficiency of insulin actions, increased accumulation of advanced glycation end products and microangiopahty. The combination of subsequent poor bone quality of micro- or nano-architecture and frequent injurious falls would be related to an increase of fracture incidence. Several recent reports have revealed that older women with diabetes had a particularly increased risk of fractures. Bone mineral density (BMD) is the best predictor for fractures of primary osteoporosis, and increased risk for fractures of the type 1 diabetes is associated with the decrease of BMD, but not on the type 2 diabetes. The patients frequently show an increase of BMD, but suffer from fractures. At present, there is mostly no data what kind of intervention or pharmaceutical therapy is the best to avoid the incidence. Some in vivo studies support that vitamin K(2) (menatetrenone) may ameliorate bone quality damage in diabetics.