Underlying mechanisms between diabetes mellitus and osteoporosis

Abstract

Several studies have linked diabetes mellitus with an increased risk of bone fractures. Patients with type 1 diabetes have lower bone mineral density and patients with type 2 diabetes have an increased risk of fracture despite normal or high bone mineral density, measured by dual energy x-ray absorptiometry. Different mechanisms have been proposed in the pathophysiology of bone disease in diabetic patients. The mechanisms involved include microvasculature changes, advanced glycation end products accumulation, and altered osteoblast-osteoclast function with increased sclerostin, decreased insulin-like growth factor 1 (IGF1), decreased osteocalcin, and other molecular alterations, leading to a decrease in bone turnover and altered bone quality. Other factors, such as increased risk of falls related to diabetic neuropathy and diabetic retinopathy have also been proposed. Different diagnostic methods have been described for the study of bone disease in patients with diabetes, due to the lack of correlation between bone mineral density measured by dual x-ray absorptiometry and the fracture risk in this group of patients. These methods include the evaluation of bone turnover markers, the FRAX score, the trabecular bone score, and the evaluation of microarchitecture with high-resolution peripheral quantitative tomography. This editorial provides a short overview of the underlying mechanisms between diabetes mellitus and osteoporosis, and the diagnostic methods used to evaluate these patients.