In addition to general factors such as previous fractures or a corresponding family history, disease-specific risk factors increase the risk of bone fractures in people with diabetes. Caution is therefore required, especially in the case of prolonged diabetes, an unfavorable metabolic situation, insulin therapy or late complications from diabetes.
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The main reason why, for example, a obesity the risk for bone fractures is due to the inflammatory effects of severe obesity, explained Prof. Dr. Nikola Napoli from Washington University School of Medicine, St. Louis. The inflammatory processes that have a negative impact on cardiovascular health are also associated with a loss of bone mass: “The higher the cytokine level in the serum, the poorer the bone quality,” the speaker put it in a nutshell.
Elevated insulin levels or insulin resistance also affect bone density. Higher values in the HOMA-IR index provide an indication of this. However, not only people with Typ-2-Diabetes endangered, but also with one Type 1 diabetes the risk of fracture should not be underestimated. Compared to people with a healthy metabolism, their chances of breaking a hip are five times higher, emphasized Prof. Richard Eastell, University of Sheffield. With type 2 diabetes, the risk is “only” increased by a third. In addition, prolonged disease duration, glycemic control, and insulin use increase the likelihood of fracture.
“But bone density doesn’t tell us the full story,” Prof. Eastell continues. The fact that even with the same values the fracture risk for people with diabetes is higher, can be explained, especially with falls as a result Hypoglykämien explain how they occur more frequently in therapy with insulin or sulfonylureas. “These falls are responsible for about 10% of all fractures in people with diabetes.” Diabetic Neuropathies or a restricted one eyesightwhich further increase the likelihood of falls, should also be considered when assessing fracture risk.
Bones act as an endocrine organ on the metabolism
In addition to the influence of glucose metabolism on bone substance, it seems glucoregulatory activity in bone to give like Dr. Kim Loh of St. Vincent’s Institute of Medical Research in Melbourne, Australia. “Bones act as an endocrine organ that influences glucose metabolism in various ways.” The hormones osteocalcin, lipocalin-2 and sclerostin produced in bones also have an effect in the pancreas, brain, liver, muscle and white adipose tissue.
It is known from mouse models that osteocalcin improves glucose uptake in muscles and beta cell function, and inhibits liver glucose secretion. Lipocalin-2 has a similar effect, whereas high levels of sclerostin are associated with decreased insulin sensitivity, decreased muscle glucose uptake, increased lipogenesis, and impaired beta cell function.
Quelle: EASD Annual Meeting 2021
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