Type 2 diabetes (T2D) is associated with an increased risk of fracture, which has been reported in several epidemiological studies. However, bone mineral density in T2D is increased and underestimates the fracture risk. Common risk factors for fracture do not fully explain the increased fracture risk observed in patients with T2D. We propose that the pathogenesis of increased fracture risk in T2D is due to low bone turnover caused by osteocyte dysfunction resulting in bone microcracks and fractures. Increased levels of sclerostin may mediate the low bone turnover and may be a novel marker of increased fracture risk, although further research is needed. An impaired incretin response in T2D may also affect bone turnover. Accumulation of advanced glycosylation endproducts may also impair bone strength. Concerning antidiabetic medication, the glitazones are detrimental to bone health and associated with increased fracture risk, and the sulphonylureas may increase fracture risk by causing hypoglycemia. So far, the results on the effect of other antidiabetics are ambiguous. No specific guideline for the management of bone disease in T2D is available and current evidence on the effects of antiosteoporotic medication in T2D is sparse. The aim of this review is to collate current evidence of the pathogenesis, detection and treatment of diabetic bone disease.

Citations

Citations to this article as recorded by  

• Effects of Exogenous GIP and GLP-2 on Bone Turnover in Individuals With Type 2 Diabetes
  Kirsa Skov-Jeppesen, Charlotte B Christiansen, Laura S Hansen, Johanne A Windeløv, Nora Hedbäck, Lærke S Gasbjerg, Morten Hindsø, Maria S Svane, Sten Madsbad, Jens J Holst, Mette M Rosenkilde, Bolette Hartmann
  The Journal of Clinical Endocrinology & Metabolism.2024; 109(7): 1773.     CrossRef
• The association between type 2 diabetes mellitus/prediabetes status and femoral neck bone mineral density in old adults
  Bo Wang, Chenhao Shi, Zhongxin Zhu
  Journal of Orthopaedic Surgery.2024;[Epub]     CrossRef
• The single point insulin sensitivity estimator (SPISE) is associated with bone health in Arab adults
  Nasser M. Al-Daghri, Kaiser Wani, Malak N. K. Khattak, Abdullah M. Alnaami, Yousef Al-Saleh, Shaun Sabico
  Aging Clinical and Experimental Research.2024;[Epub]     CrossRef
• Single-cell RNA sequencing reveals a distinct profile of bone immune microenvironment and decreased osteoclast differentiation in type 2 diabetic mice
  Zimei Wu, Qiaodan Hou, Heng Chi, Jihong Liu, Yixin Mei, Tingting Chen, Kunkun Yang, Jingna Zheng, Jing Xu, Fuxin Wei, Lin Wang
  Genes & Diseases.2024; 11(6): 101145.     CrossRef
• Assessment of fracture risk in diabetic patients
  Zhenpeng Wang, Mei Zhang, Dan Jia
  Journal of Diabetes & Metabolic Disorders.2024;[Epub]     CrossRef
• Planetary Health Diet – geeignet für Menschen mit Typ-2-Diabetes?
  Pauline Weimer, Claudia Mews, Dagmar Lühmann, Thomas Kloppe
  Zeitschrift für Allgemeinmedizin.2024;[Epub]     CrossRef
• Bone parameters in T1D and T2D assessed by DXA and HR-pQCT – A cross-sectional study: The DIAFALL study
  Nicklas Højgaard-hessellund Rasmussen, Jakob Dal, Annika Vestergaard Kvist, Joop P. van den Bergh, Morten Hasselstrøm Jensen, Peter Vestergaard
  Bone.2023; 172: 116753.     CrossRef
• Clinical risk factors analysis and prevention of osteoporosis as a complication of diabetes
  Jiaojiao Wang, Hang Li, Haihong Zhu, Xinyan Xie, Qiyue Zheng, Jian Qu, Haiyan Yuan, Ting Liu, Qiong Lu
  International Journal of Diabetes in Developing Countries.2023;[Epub]     CrossRef
• Effects of a Lifestyle Intervention on Bone Turnover in Persons with Type 2 Diabetes: A Post Hoc Analysis of the U-TURN Trial
  JULIE ABILDGAARD, METTE YUN JOHANSEN, KIRSA SKOV-JEPPESEN, LARS BO ANDERSEN, KRISTIAN KARSTOFT, KATRINE BAGGE HANSEN, BOLETTE HARTMANN, JENS JUUL HOLST, BENTE KLARLUND PEDERSEN, MATHIAS RIED-LARSEN
  Medicine & Science in Sports & Exercise.2022; 54(1): 38.     CrossRef
• The Effects of 12-Weeks Whey Protein Supplements on Markers of Bone Turnover in Adults With Abdominal Obesity – A Post Hoc Analysis
  Rasmus Fuglsang-Nielsen, Elin Rakvaag, Peter Vestergaard, Kjeld Hermansen, Søren Gregersen, Jakob Starup-Linde
  Frontiers in Endocrinology.2022;[Epub]     CrossRef
• Diabetes and osteoporosis – Treating two entities: A challenge or cause for concern?
  Nicklas H. Rasmussen, Peter Vestergaard
  Best Practice & Research Clinical Rheumatology.2022; 36(3): 101779.     CrossRef
• Do proximal hip geometry, trabecular microarchitecture, and prevalent vertebral fractures differ in postmenopausal women with type 2 diabetes mellitus? A cross-sectional study from a teaching hospital in southern India
  J. Paul, V. Devarapalli, J. T. Johnson, K. E. Cherian, F. K. Jebasingh, H. S. Asha, N. Kapoor, N. Thomas, T. V. Paul
  Osteoporosis International.2021; 32(8): 1585.     CrossRef
• Investigation of Mechanical, Material, and Compositional Determinants of Human Trabecular Bone Quality in Type 2 Diabetes
  Praveer Sihota, Ram Naresh Yadav, Ruban Dhaliwal, Jagadeesh Chandra Bose, Vandana Dhiman, Deepak Neradi, Shailesh Karn, Sidhartha Sharma, Sameer Aggarwal, Vijay G Goni, Vishwajeet Mehandia, Deepak Vashishth, Sanjay Kumar Bhadada, Navin Kumar
  The Journal of Clinical Endocrinology & Metabolism.2021; 106(5): e2271.     CrossRef
• The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions
  J.P. van den Bergh, P. Szulc, A.M. Cheung, M. Bouxsein, K. Engelke, R. Chapurlat
  Osteoporosis International.2021; 32(8): 1465.     CrossRef
• Characteristics of bone metabolism in postmenopausal women with newly diagnosed type 2 diabetes mellitus
  Huijuan Li, Yuhua Wen, Peipei Liu, Liya Zhang, Xiaoya Zhang, Yichen Liu, Bin Ma, Haidong Kuang, Jianxin Wang, Lige Song
  Clinical Endocrinology.2021; 95(3): 430.     CrossRef
• Associations between markers of glucose metabolism and bone measures among diabetic and non-diabetic adults
  Kelly Virecoulon Giudici, Natasha Aparecida Grande de França, Bárbara Santarosa Emo Peters, Regina Mara Fisberg, Lígia Araújo Martini
  Journal of Diabetes & Metabolic Disorders.2021; 20(2): 1247.     CrossRef
• Diabetes increases the risk of bone fractures in patients on kidney replacement therapy: A Danish national cohort study
  Sabina Chaudhary Hauge, Bo Abrahamsen, Gunnar Gislason, Jonas Bjerring Olesen, Kristine Hommel, Ditte Hansen
  Bone.2021; 153: 116158.     CrossRef
• Comparison of the Effects of Various Antidiabetic Medication on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus
  Jeonghoon Ha, Yejee Lim, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Ho Song, Seung Hyun Ko, Moo Il Kang, Sung Dae Moon, Ki-Hyun Baek
  Endocrinology and Metabolism.2021; 36(4): 895.     CrossRef
• Can fingernail quality predict bone damage in Type 2 diabetes mellitus? a pilot study
  Praveer Sihota, Rimesh Pal, Ram Naresh Yadav, Deepak Neradi, Shailesh Karn, Vijay G. Goni, Siddhartha Sharma, Vishwajeet Mehandia, Sanjay Kumar Bhadada, Navin Kumar, Sudhaker D. Rao, Subburaman Mohan
  PLOS ONE.2021; 16(9): e0257955.     CrossRef
• Do patients with diabetes have an increased risk of impaired fracture healing? A systematic review and meta‐analysis
  Zi‐chuan Ding, Wei‐nan Zeng, Xiao Rong, Zhi‐min Liang, Zong‐ke Zhou
  ANZ Journal of Surgery.2020; 90(7-8): 1259.     CrossRef
• Association between abdominal obesity and fragility fractures among elderly Israeli women
  Orit Ofir, Assaf Buch, Vanessa Rouach, Rebecca Goldsmith, Naftali Stern, Efrat Monsonego-Ornan
  Aging Clinical and Experimental Research.2020; 32(8): 1459.     CrossRef
• Diabetes and fractures: new evidence of atypical femoral fractures?
  N.H. Rasmussen, J. Dal, F. de Vries, J.P. van den Bergh, M.H. Jensen, P. Vestergaard
  Osteoporosis International.2020; 31(3): 447.     CrossRef
• Association of glycaemic variables with trabecular bone score in post‐menopausal women with type 2 diabetes mellitus
  B. Depczynski, P. Y. Liew, C. White
  Diabetic Medicine.2020; 37(9): 1545.     CrossRef
• Understanding Bone Disease in Patients with Diabetic Kidney Disease: a Narrative Review
  Sabina Chaudhary Hauge, Morten Frost, Ditte Hansen
  Current Osteoporosis Reports.2020; 18(6): 727.     CrossRef
• Falls and Fractures in Diabetes—More than Bone Fragility
  Nicklas Højgaard Rasmussen, Jakob Dal
  Current Osteoporosis Reports.2019; 17(3): 147.     CrossRef
• Role of Metformin on Osteoblast Differentiation in Type 2 Diabetes
  Lin Jiating, Ji Buyun, Zhang Yinchang
  BioMed Research International.2019; 2019: 1.     CrossRef
• An update on therapies for the treatment of diabetes-induced osteoporosis
  Sahar Mohsin, May MYH Baniyas, Reem SMH AlDarmaki, Kornélia Tekes, Huba Kalász, Ernest A. Adeghate
  Expert Opinion on Biological Therapy.2019; 19(9): 937.     CrossRef