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Review
. 2016 Jul;65(7):1757-66.
doi: 10.2337/db16-0063.

Skeletal Metabolism, Fracture Risk, and Fracture Outcomes in Type 1 and Type 2 Diabetes

Deborah E Sellmeyer  1 , Roberto Civitelli  2 , Lorenz C Hofbauer  3 , Sundeep Khosla  4 , Beata Lecka-Czernik  5 , Ann V Schwartz  6
Affiliations
Review

Skeletal Metabolism, Fracture Risk, and Fracture Outcomes in Type 1 and Type 2 Diabetes

Deborah E Sellmeyer et al. Diabetes. 2016 Jul.

Abstract

Fracture risk is significantly increased in both type 1 and type 2 diabetes, and individuals with diabetes experience worse fracture outcomes than normoglycemic individuals. Factors that increase fracture risk include lower bone mass in type 1 diabetes and compromised skeletal quality and strength despite preserved bone density in type 2 diabetes, as well as the effects of comorbidities such as diabetic macro- and microvascular complications. In this Perspective, we assess the developing scientific knowledge regarding the epidemiology and pathophysiology of skeletal fragility in patients with diabetes and the emerging data on the prediction, treatment, and outcomes of fractures in individuals with type 1 and type 2 diabetes.

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Figures

Figure 1
Figure 1
Femoral neck BMD T-score and 10-year fracture risk at age 75 years by diabetes status and insulin use. Estimated 10-year cumulative fracture risk at age 75 years in men and women, calculated using the Cox proportional hazards regression model baseline survival function raised to the power of the relative hazard for each combination of diabetes group and T-score. DM, diabetes. Adapted with permission from Schwartz et al. (18).
Figure 2
Figure 2
Median (by total volumetric BMD) HR-pQCT images of the distal radius from control (top) and T2D (bottom) subjects: distal-most slices (A and E), proximal-most slices (B and F), three-dimensional visualization of the mineralized bone structure (C and G), and three-dimensional visualization of cortical bone (transparent gray) and cortical porosity (dark gray dots) (D and H). Reprinted with permission from Burghardt et al. (59).
Figure 3
Figure 3
Unadjusted (A) and BMI-adjusted (B) comparisons of bone material strength between patients with T2D and age-matched control subjects without diabetes. Values are shown as mean ± SE. ‡P < 0.001. Reprinted with permission from Farr et al. (61).
See this image and copyright information in PMC

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