Diabetes and bone health

Abstract

The increasing prevalence of diabetes especially type 2 diabetes worldwide is indisputable. Diabetics suffer increased morbidity and mortality, compared to their non-diabetic counterparts, not only because of vascular complications, but also because of an increased fracture incidence. Both types 1 and 2 diabetes and some medications used to treat it are associated with osteoporotic fractures. The responsible mechanisms remain incompletely elucidated. In this review, we evaluate the role of glycemic control in bone health, and the effect of anti-diabetic medications such as thiazolidinediones, sulfonylureas, DPP-4 inhibitors, and GLP-1 agonists. In addition, we examine the possible role of insulin and metformin as anabolic agents for bone. Lastly, we identify the current and future screening tools that help evaluate bone health in diabetics and their limitations. In this way we can offer individualized treatment, to the at-risk diabetic population.

Keywords: AGEs; BMD; CAH; DM; DPP-4; DXA; Diabetes; FRAX; FSH; Fractures; GH; GIP; GLP; IGF-1; IGFBP3; LH; Osteoporosis; PCOS; PPAR-gamma agonists; PTH; SHBG; TZDs; Thiazolidinediones; advanced glycation endproducts; bone mineral density; congenital adrenal hyperplasia; diabetes mellitus; dipeptydil petptidase-4; dual-energy X-ray absorptiometry; follicle stimulating hormone; fracture risk assessment tool; gastric inhibitory polypeptide; glucagon like peptide; growth hormone; insulin like growth factor 1; insulin-like growth factor binding protein 3; luteinizing hormone; parathyroid hormone; peroxisome proliferator-activated receptor gamma; polycystic ovarian syndrome; sex hormone binding globulin; thiazolidinediones.