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Diabetes and Bone: Still a Lot to Learn

  • Skeletal and calcium controversies in diabetes mellitus, cardiovascular disease, and lipid disorders
  • Published:
Clinical Reviews in Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Both type 2 diabetes mellitus (T2DM) and osteoporosis are increasing worldwide. There is a large body of knowledge pointing to the association of these two diseases with a potential increased risk of falls and fractures in patients with diabetes. Whereas patients with type 1 diabetes have a low bone mineral density (BMD), those with T2DM tend to have a high BMD rendering the task difficult for clinicians to diagnose bone “weakness” and identify patients at higher risk of fractures. The duration and type of diabetes and glycemic control seem to affect fracture risk. Several underlying pathophysiologic pathways and factors are increasingly linking glucose and bone homeostasis. Factors secreted by bone such as osteocalcin and osteoprotegerin seem to affect glucose metabolism, while hyperglycemia, insulin and advanced glycation end products appear to disrupt bone quality. Adipocytokines, mainly leptin and adiponectin, are major players in the pathophysiology of those two diseases. Vitamin D and parathyroid hormone, the main two regulators of calcium and bone metabolism, have an important role in diabetes too. Yet, there is still some controversy surrounding few of those mechanisms and interactions. In this review, we will summarize available evidence illustrating the intimate interaction between glucose and bone homeostasis and highlight studies examining fracture and fall risk in patients with diabetes.

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Joumana T. Chaiban and Kristine G. Nicolas have no financial or any other kind of personal conflicts with this paper.

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  1. Endocrinology Division, Internal Medicine Department, Case Western Reserve University/St. Vincent Charity Medical Center, 2351 East 22nd Street, Cleveland, OH, 44115, USA

    Joumana T. Chaiban

  2. Internal Medicine Department, Southern California Permanente Medical Group, Ontario, CA, USA

    Kristine G. Nicolas

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Chaiban, J.T., Nicolas, K.G. Diabetes and Bone: Still a Lot to Learn. Clinic Rev Bone Miner Metab 13, 20–35 (2015). https://doi.org/10.1007/s12018-015-9178-9

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