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Type 2 diabetes and bone.

William D Leslie¹, Mishaela R Rubin, Ann V Schwartz

¹Department of Medicine, University of Manitoba, Winnipeg, Canada. bleslie@sbgh.mb.ca

Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research

|October 2, 2012

Summary

This summary is machine-generated.

Type 2 diabetes increases fracture risk despite normal bone density. This suggests underlying issues with bone quality, necessitating better fracture prediction methods for older adults with diabetes.

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Area of Science:

Endocrinology
Metabolic Bone Disease
Geriatric Medicine

Background:

Type 2 diabetes (T2D) is a growing global health concern, particularly in older populations.
T2D is recognized as an independent risk factor for fractures.
Paradoxically, T2D is often associated with normal or increased bone mineral density (BMD) measured by DXA.

Purpose of the Study:

To investigate the hypothesis that diabetes-associated alterations in bone material and structural properties contribute to increased fracture risk.
To highlight the limitations of current fracture prediction methods, such as FRAX, in individuals with T2D.
To emphasize the urgent need for improved fracture risk assessment in older adults with T2D.

Main Methods:

Review of existing research on diabetes, bone density, and fracture risk.
Analysis of the potential impact of advanced glycation end products on collagen.
Consideration of low bone turnover states and subtle cortical abnormalities.

Main Results:

Fracture risk in T2D may stem from compromised biomechanical competence due to altered bone quality, not just low BMD.
Current clinical tools like FRAX may underestimate fracture risk in T2D patients.
Overly glycated collagen and low bone turnover are potential contributing factors.

Conclusions:

The paradox of normal BMD and high fracture risk in T2D suggests a critical need to assess bone quality.
Development of new fracture prediction tools incorporating diabetes-specific factors is a priority.
Further research using large population cohorts is required to refine fracture risk algorithms for T2D patients.