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Tatlı Kemikler: Diabetes Mellitus’un Kemik Sağlığına Etkisi

Year 2022, Volume: 15 Issue: 2, 240 - 245, 15.04.2022
https://doi.org/10.46483/deuhfed.927575

Abstract

Diabetes mellitus, dünya çapında milyonlarca nüfusu etkileyen, önemli mortalite ve morbiditeye sahip, kronik hiperglisemik, yaygın bir hastalıktır. Diyabetin kardiyovasküler sistem, göz, böbrek ve sinir sistemi üzerinde iyi bilinen komplikasyonlarının yanı sıra iskelet sistemide diyabetten etkilenir. Son zamanlarda diyabetin iskelet sistemini olumsuz etkilediği, kemik kalitesinde ve kemik gücünde bozulma, artan kırık riski ve bozulmuş kemik iyileşmesi gibi kemik üzerine zararlı etkilerinin olduğunu gösteren kanıtlar artmaktadır. Diyabetin kemik sağlığı üzerinde güçlü bir etkisi vardır ve iskelet kırılganlığı artık hem Tip 1 hem de Tip 2 diyabetin önemli bir komplikasyonu olarak kabul edilmektedir. Tip 1 diyabette kemik mineral yoğunluğunun azalması, Tip 2 diyabette ise kemik yoğunluğunun normal hatta daha yüksek olmasına rağmen, kemik kalitesinin ve gücünün bozulması kırık riskini artırır. Tip 1 ve Tip 2 diyabetin geç aşamalarında, insülin eksikliği, insülin benzeri büyüme faktörü 1’in yetersiz salınımı kemik homeostazını bozarak kırılganlığa yol açabilir. Kemik kırılganlığına yol açan patofizyolojik mekanizmalar çok faktörlüdür ve potansiyel olarak kemik oluşumunun bozulmasına, kemik yapısının değişmesine ve kemik gücünün azalmasına yol açar. İlginç bir şekilde farklı antidiyabetik tedaviler, glisemik kontrol, hipoglisemik olayların tetiklenmesi, kemik oluşumu üzerindeki etkileri nedeniyle kırık riskini etkileyebilir. Bu derlemede, diyabetin kemik homeostazına etkisi, kırık riski, antidiyabetik tedavinin kemik üzerine etkisi ve sağlık personeline öneriler tartışılmaktadır.

Supporting Institution

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References

  • 1. TEMD Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu-2020. 14. Basım (Çevrimiçi Yayın). Ankara.
  • 2. Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M. Update on the impact of type 2 diabetes mellitus on bone metabolism and material properties. Endocr Connect 2019;8(3):R55-R70.
  • 3. Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL. & IOF Bone and Diabetes Working Group. Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol 2017;13:208–219.
  • 4. Rathinavelu S, Guidry-Elizondo C, Banu J. Molecular modulation of osteoblasts and osteoclasts in type 2 diabetes. J Diabetes Res 2018;6354787.
  • 5. Murray CE, Coleman CM. Impact of diabetes mellitus on bone health. Int J Mol Sci 2019;20(19):4873.
  • 6. Loder RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 1988;(232):210-6.
  • 7. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 1999;13(5):369-72.
  • 8. Retzepi M, Donos N. The effect of diabetes mellitus on osseous healing. Clin Oral Implants Res 2010;21(7):673-81.
  • 9. Keleştimur H. Paratiroit hormonu ve kalsiyum-fosfat metabolizması. İçinde Ağar E, İnsan fizyolojisi.1. Basım. İstanbul Tıp Kitapevleri; 2021:966-967.
  • 10. Kanazawa I, Sugimoto T. Diabetes mellitus-induced bone fragility. Intern Med 2018;57(19):2773-2785.
  • 11. Eller-Vainicher C, Cairoli E, Grassi G, Grassi F, Catalano A, Merlotti D, et al. Pathophysiology and management of type 2 diabetes mellitus bone fragility. J Diabetes Res 2020;7608964.
  • 12. Al-Hariri M. Sweet Bones: The Pathogenesis of bone alteration in diabetes. J Diabetes Res 2016;2016:6969040.
  • 13. Lecka-Czernik B. Diabetes, bone and glucose-lowering agents: basic biology. Diabetologia 2017;60(7):1163-1169.
  • 14. Valderrábano RJ, Linares MI. Diabetes mellitus and bone health: epidemiology, etiology and implications for fracture risk stratification. Clin Diabetes Endocrinol 2018;4:9.
  • 15. Wang L, Li T, Liu J, Wu X, Wang H, Li X, et al. Association between glycosylated hemoglobin A1c and bone biochemical markers in type 2 diabetic postmenopausal women: a cross-sectional study. BMC Endocr Disord 2019;19(1):31.
  • 16. Canecki-Varžić S, Prpić-Križevac I, Bilić-Ćurčić I. Plasminogen activator inhibitor-1 concentrations and bone mineral density in postmenopausal women with type 2 diabetes mellitus. BMC Endocr Disord 2016;16:14.
  • 17. Chaiban JT, Nicolas KG. Diabetes and bone still a lot to learn. Clinic Rev Bone Miner Metab 2015;13(1):20–35.
  • 18. Palermo A, D’Onofrio L, Buzzetti R, Manfrini S, Napoli N. Pathophysiology of bone fragility in patients with diabetes. Calcif Tissue Int 2017;100(2):122–132.
  • 19. Piccinin MA, Khan ZA. Pathophysiological role of enhanced bone marrow adipogenesis in diabetic complications. Adipocytes 2014;3(4):263–272.
  • 20. Janghorbani M, Feskanich D, Willett WC, Hu F. Prospective study of diabetes and risk of hip fracture: The nurses’ health study. Diabetes Care 2006;29(7):1573-8.
  • 21. Madsen JOB, Jørgensen NR, Pociot F, Johannesen J. Bone turnover markers in children and adolescents with type 1 diabetes-a systematic review. Pediatr Diabetes 2019;20:510–522.
  • 22. Takashi Y, Ishizu M, Mori H, Miyashita K, Sakamoto F, Katakami N, et al. Circulating osteocalcin as a bone-derived hormone is inversely correlated with body fat in patients with type 1 diabetes. PLoS ONE 2019;14:e0216416.
  • 23. Massera D, Biggs ML, Walker MD, Mukamal KJ, Ix JH, Djousse L, et al. Biochemical markers of bone turnover and risk of ıncident diabetes in older women: the cardiovascular health study. Diabetes Care 2018;41:1901–1908.
  • 24. Vlot MC, den Heijer M, de Jongh RT, Vervloet MG, Lems WF, de Jonge R., et al. Clinical utility of bone markers in various diseases. Bone 2018;114:215–225.
  • 25. Kanazawa I, Yamaguchi T, Yamauchi M, Yamamoto M, Kurioka S, Yano S, et al. Adiponectin is associated with changes in bone markers during glycemic control in type 2 diabetes mellitus. J Clin Endocrinol Metab 2009;94(8):3031-7.
  • 26. Kanazawa I, Yamaguchi T, Sugimoto T. Relationship between bone biochemical markers versus glucose/lipid metabolism and atherosclerosis; a longitudinal study in type 2 diabetes mellitus. Diabetes Res Clin Pract 2011;92:393-399.
  • 27. Lee RH, Sloane R, Pieper C, Lyles KW, Adler RA, Van Houtven C, LaFleur J, Colón-Emeric C. Glycemic control and ınsulin treatment alter fracture risk in older men with type 2 diabetes mellitus. J Bone Miner Res 2019;34(11):2045-2051.
  • 28. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001;86(1):32–38.
  • 29. Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 2009;24(4):702–709.
  • 30. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 2007;166:495–505.
  • 31. Fan Y, Wei F, Lang Y, Liu Y. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int 2016;27:219–228.
  • 32. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls. Diabetes Care 2002;25(10):1749–1754.
  • 33. Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, De Rekeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care 2008;31(3):391–396.
  • 34. Lafage-Proust MH, Roche B, Langer M, Cleret D, Vanden Bossche A, Olivier T, et al. Assessment of bone vascularization and its role in bone remodeling. Bonekey Rep 2015;4:662.
  • 35. Costantini S, Conte C. Bone health in diabetes and prediabetes. World J Diabetes 2019;10(8):421-445.
  • 36. Conte C, Epstein S, Napoli N. Insulin resistance and bone: a biological partnership. Acta Diabetologica 2018;55(4):305–314.
  • 37. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A consensus report by the american diabetes association (ada) and the european association for the study of diabetes (EASD) Diabetes Care 2018;41:2669–2701.
  • 38. Palermo A, D’Onofrio L, Eastell R, Schwartz AV, Pozzilli P, Napoli N. Oral anti-diabetic drugs and fracture risk, cut to the bone: safe or dangerous? A narrative review. Osteoporos Int 2015;26(8):2073–2089.
  • 39. Majumdar SR, Josse RG, Lin M, Eurich DT. Does Sitagliptin affect the rate of osteoporotic fractures in type 2 diabetes? Population-based cohort study. J Clin Endocrinol Metab 2016;101:1963–1969.
  • 40. Starup-Linde J, Gregersen S, Frost M, Vestergaard P. Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes. Bone 2017;95:136–142.

Sweet Bones: The Effect of Dıabetes Mellıtus on Bone Health

Year 2022, Volume: 15 Issue: 2, 240 - 245, 15.04.2022
https://doi.org/10.46483/deuhfed.927575

Abstract

Diabetes mellitus is a chronic hyperglycemic, common disease with significant mortality and morbidity affecting millions of people worldwide. Besides the well-known complications of diabetes on the cardiovascular system, eyes, kidneys and nervous system, bone is also affected by diabetes. Recently, there is increasing evidence that diabetes affects the skeletal system negatively and has harmful effects on bone, such as impaired bone quality and bone strength, increased risk of fractures and impaired bone healing. Diabetes has a strong impact on bone health, and skeletal fragility is now recognized as a major complication of both Type 1 and Type 2 diabetes. Decrease in bone mineral density in Type 1 diabetes, and deterioration in bone quality and strength, although bone density is normal or higher in Type 2 diabetes, increases the risk of fracture. In the late stages of Type 1 and Type 2 diabetes, insulin deficiency, insufficient release of insulin-like growth factor 1 can disrupt bone homeostasis and lead to fragility. Pathophysiological mechanisms that lead to bone fragility are multifactorial and potentially lead to impaired bone formation, altered bone structure, and reduced bone strength. Interestingly, different antidiabetic treatments can affect fracture risk due to glycemic control, triggering of hypoglycemic events, and effects on bone formation. In this review, the effect of diabetes on bone homeostasis, fracture risk, and the effect of antidiabetic therapy on bone recommendations to healthcare professionals are discussed.

References

  • 1. TEMD Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu-2020. 14. Basım (Çevrimiçi Yayın). Ankara.
  • 2. Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M. Update on the impact of type 2 diabetes mellitus on bone metabolism and material properties. Endocr Connect 2019;8(3):R55-R70.
  • 3. Napoli N, Chandran M, Pierroz DD, Abrahamsen B, Schwartz AV, Ferrari SL. & IOF Bone and Diabetes Working Group. Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol 2017;13:208–219.
  • 4. Rathinavelu S, Guidry-Elizondo C, Banu J. Molecular modulation of osteoblasts and osteoclasts in type 2 diabetes. J Diabetes Res 2018;6354787.
  • 5. Murray CE, Coleman CM. Impact of diabetes mellitus on bone health. Int J Mol Sci 2019;20(19):4873.
  • 6. Loder RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 1988;(232):210-6.
  • 7. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 1999;13(5):369-72.
  • 8. Retzepi M, Donos N. The effect of diabetes mellitus on osseous healing. Clin Oral Implants Res 2010;21(7):673-81.
  • 9. Keleştimur H. Paratiroit hormonu ve kalsiyum-fosfat metabolizması. İçinde Ağar E, İnsan fizyolojisi.1. Basım. İstanbul Tıp Kitapevleri; 2021:966-967.
  • 10. Kanazawa I, Sugimoto T. Diabetes mellitus-induced bone fragility. Intern Med 2018;57(19):2773-2785.
  • 11. Eller-Vainicher C, Cairoli E, Grassi G, Grassi F, Catalano A, Merlotti D, et al. Pathophysiology and management of type 2 diabetes mellitus bone fragility. J Diabetes Res 2020;7608964.
  • 12. Al-Hariri M. Sweet Bones: The Pathogenesis of bone alteration in diabetes. J Diabetes Res 2016;2016:6969040.
  • 13. Lecka-Czernik B. Diabetes, bone and glucose-lowering agents: basic biology. Diabetologia 2017;60(7):1163-1169.
  • 14. Valderrábano RJ, Linares MI. Diabetes mellitus and bone health: epidemiology, etiology and implications for fracture risk stratification. Clin Diabetes Endocrinol 2018;4:9.
  • 15. Wang L, Li T, Liu J, Wu X, Wang H, Li X, et al. Association between glycosylated hemoglobin A1c and bone biochemical markers in type 2 diabetic postmenopausal women: a cross-sectional study. BMC Endocr Disord 2019;19(1):31.
  • 16. Canecki-Varžić S, Prpić-Križevac I, Bilić-Ćurčić I. Plasminogen activator inhibitor-1 concentrations and bone mineral density in postmenopausal women with type 2 diabetes mellitus. BMC Endocr Disord 2016;16:14.
  • 17. Chaiban JT, Nicolas KG. Diabetes and bone still a lot to learn. Clinic Rev Bone Miner Metab 2015;13(1):20–35.
  • 18. Palermo A, D’Onofrio L, Buzzetti R, Manfrini S, Napoli N. Pathophysiology of bone fragility in patients with diabetes. Calcif Tissue Int 2017;100(2):122–132.
  • 19. Piccinin MA, Khan ZA. Pathophysiological role of enhanced bone marrow adipogenesis in diabetic complications. Adipocytes 2014;3(4):263–272.
  • 20. Janghorbani M, Feskanich D, Willett WC, Hu F. Prospective study of diabetes and risk of hip fracture: The nurses’ health study. Diabetes Care 2006;29(7):1573-8.
  • 21. Madsen JOB, Jørgensen NR, Pociot F, Johannesen J. Bone turnover markers in children and adolescents with type 1 diabetes-a systematic review. Pediatr Diabetes 2019;20:510–522.
  • 22. Takashi Y, Ishizu M, Mori H, Miyashita K, Sakamoto F, Katakami N, et al. Circulating osteocalcin as a bone-derived hormone is inversely correlated with body fat in patients with type 1 diabetes. PLoS ONE 2019;14:e0216416.
  • 23. Massera D, Biggs ML, Walker MD, Mukamal KJ, Ix JH, Djousse L, et al. Biochemical markers of bone turnover and risk of ıncident diabetes in older women: the cardiovascular health study. Diabetes Care 2018;41:1901–1908.
  • 24. Vlot MC, den Heijer M, de Jongh RT, Vervloet MG, Lems WF, de Jonge R., et al. Clinical utility of bone markers in various diseases. Bone 2018;114:215–225.
  • 25. Kanazawa I, Yamaguchi T, Yamauchi M, Yamamoto M, Kurioka S, Yano S, et al. Adiponectin is associated with changes in bone markers during glycemic control in type 2 diabetes mellitus. J Clin Endocrinol Metab 2009;94(8):3031-7.
  • 26. Kanazawa I, Yamaguchi T, Sugimoto T. Relationship between bone biochemical markers versus glucose/lipid metabolism and atherosclerosis; a longitudinal study in type 2 diabetes mellitus. Diabetes Res Clin Pract 2011;92:393-399.
  • 27. Lee RH, Sloane R, Pieper C, Lyles KW, Adler RA, Van Houtven C, LaFleur J, Colón-Emeric C. Glycemic control and ınsulin treatment alter fracture risk in older men with type 2 diabetes mellitus. J Bone Miner Res 2019;34(11):2045-2051.
  • 28. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001;86(1):32–38.
  • 29. Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 2009;24(4):702–709.
  • 30. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 2007;166:495–505.
  • 31. Fan Y, Wei F, Lang Y, Liu Y. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int 2016;27:219–228.
  • 32. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls. Diabetes Care 2002;25(10):1749–1754.
  • 33. Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, De Rekeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care 2008;31(3):391–396.
  • 34. Lafage-Proust MH, Roche B, Langer M, Cleret D, Vanden Bossche A, Olivier T, et al. Assessment of bone vascularization and its role in bone remodeling. Bonekey Rep 2015;4:662.
  • 35. Costantini S, Conte C. Bone health in diabetes and prediabetes. World J Diabetes 2019;10(8):421-445.
  • 36. Conte C, Epstein S, Napoli N. Insulin resistance and bone: a biological partnership. Acta Diabetologica 2018;55(4):305–314.
  • 37. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A consensus report by the american diabetes association (ada) and the european association for the study of diabetes (EASD) Diabetes Care 2018;41:2669–2701.
  • 38. Palermo A, D’Onofrio L, Eastell R, Schwartz AV, Pozzilli P, Napoli N. Oral anti-diabetic drugs and fracture risk, cut to the bone: safe or dangerous? A narrative review. Osteoporos Int 2015;26(8):2073–2089.
  • 39. Majumdar SR, Josse RG, Lin M, Eurich DT. Does Sitagliptin affect the rate of osteoporotic fractures in type 2 diabetes? Population-based cohort study. J Clin Endocrinol Metab 2016;101:1963–1969.
  • 40. Starup-Linde J, Gregersen S, Frost M, Vestergaard P. Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes. Bone 2017;95:136–142.
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Nursing
Journal Section Review
Authors

Buket Daştan 0000-0002-2458-0578

Sevilay Hintistan 0000-0002-5907-5723

Publication Date April 15, 2022
Published in Issue Year 2022 Volume: 15 Issue: 2

Cite

APA Daştan, B., & Hintistan, S. (2022). Tatlı Kemikler: Diabetes Mellitus’un Kemik Sağlığına Etkisi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 15(2), 240-245. https://doi.org/10.46483/deuhfed.927575

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