Current Osteoporosis Reports

, Volume 12, Issue 2, pp 181–188 | Cite as

Diabetes, Collagen, and Bone Quality

  • Mitsuru Saito
  • Yoshikuni Kida
  • Soki Kato
  • Keishi Marumo
Biomechanics (M Silva and P Zysset, Section Editors)

Abstract

Diabetes increases risk of fracture, although type 2 diabetes is characterized by normal or high bone mineral density (BMD) compared with the patients without diabetes. The fracture risk of type 1 diabetes as well as type 2 diabetes increases beyond an explained by a decrease of BMD. Thus, diabetes may reduce bone strength without change in BMD. Whole bone strength is determined by bone density, structure, and quality, which encompass the micro-structural and tissue material properties. Recent literature showed that diabetes reduces bone material properties rather than BMD. Collagen intermolecular cross-linking plays an important role in the expression of bone strength. Collagen cross-links can be divided into beneficial enzymatic immature divalent and mature trivalent cross-links and disadvantageous nonenzymatic cross-links (Advanced glycation end products: AGEs) induced by glycation and oxidation. The formation pathway and biological function are quite different. Not only hyperglycemia, but also oxidative stress induces the reduction in enzymatic cross-links and the formation of AGEs. In this review, we describe the mechanism of low bone quality in diabetes and the usefulness of the measurement of plasma or urinary level of AGEs for estimation of fracture risk.

Keywords

Diabetes Bone quality Collagen Cross-links Advanced glycation end products Pentosidine Homocysteine Fracture risk 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mitsuru Saito
    • 1
  • Yoshikuni Kida
    • 1
  • Soki Kato
    • 1
  • Keishi Marumo
    • 1
  1. 1.Department of Orthopaedic SurgeryJikei University School of MedicineTokyoJapan

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