Diabetes Therapies and Bone

Abstract

Both osteoporosis and diabetes are chronic conditions that affect a large proportion of the elderly population. The prevalence of diabetes is increasing. National Diabetes Statistics Report, 2020 indicates that 34.2 million or 10.5% overall US population; 34.1 million adults aged 18 years or older or 13.0% of all US adults have diabetes. Fractures are commoner in patients with type 1 and type 2 diabetes compared with persons without a diabetes. There is significant evidence to show compromised bone quality in diabetes such as hyperglycemia with increased advanced glycation end products (AGEs), decreased osteocalcin and increased PTH results in compromised mesenchymal stem cell (MSC) differentiation, and decreased osteogenesis and decreased bone turn over. That, in turn, results in reduced bone quality and decreased bone strength and resultant increase in fracture risk. The mechanisms involved include effects of insulin, insulin-like growth factor 1, cytokines, advanced glycation end products, and altered calcium homeostasis. Persons with diabetes have increased risk for falls due to poor vision, neuropathy, and/or hypoglycemia. In addition, drug-induced alterations are reported and related to diabetes therapies. Here we review the risk of fractures related to diabetes therapies.