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Skeletal fragility in diabetes.

Mishaela R Rubin1

  • 1Metabolic Bone Disease Unit, Columbia University, New York, New York.

Annals of the New York Academy of Sciences
|September 20, 2017
PubMed
Summary
This summary is machine-generated.

Patients with type 1 and type 2 diabetes face higher fracture risks. While bone density may decrease in T1D, it paradoxically increases in T2D, requiring refined fracture risk assessment.

Keywords:
AGEsFRAXdiabetesfracturemicroarchitecturemicroindentationremodeling

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Area of Science:

  • Endocrinology
  • Orthopedics
  • Metabolic Diseases

Background:

  • Type 1 diabetes (T1D) and type 2 diabetes (T2D) are associated with increased fracture risk.
  • Bone mineral density (BMD) is reduced in T1D but paradoxically elevated in T2D.
  • Diabetes impacts skeletal health through microarchitectural changes, compromised bone material properties, and altered bone metabolism.

Purpose of the Study:

  • To review the impact of diabetes on bone health and fracture risk.
  • To discuss the utility and limitations of the Fracture Risk Assessment Tool (FRAX) in diabetic patients.
  • To explore potential therapeutic strategies for managing osteoporosis in diabetes.

Main Methods:

  • Literature review of studies investigating bone health in diabetes.
  • Analysis of dual-energy X-ray absorptiometry (DXA) findings in diabetic populations.
  • Evaluation of the Fracture Risk Assessment Tool (FRAX) for predicting fractures in diabetes.

Main Results:

  • Diabetes significantly increases fracture risk, with worse outcomes (morbidity, mortality) compared to non-diabetics.
  • Skeletal abnormalities include altered microarchitecture and compromised impact microindentation.
  • Advanced glycation end products and changes in bone formation and microvasculature contribute to skeletal fragility.

Conclusions:

  • Fracture risk assessment in diabetes requires careful consideration and potential refinement of existing tools like FRAX.
  • Antiresorptive osteoporosis therapies demonstrate efficacy in managing bone fragility in diabetic patients.
  • Further research is needed to fully elucidate the complex mechanisms linking diabetes and skeletal complications.