Bone Abstracts

Diabetes mellitus is the most common metabolic disease affecting more than 300 million people worldwide with a constantly growing prevalence mainly due to an increase of obesity associated type 2 diabetes. Serious macrovascular (myocardial infarction, peripheral artery disease, and stroke) and microvascular (retinopathy and nephropathy) complications account for substantial morbidity and mortality in diabetes patients. Somewhat underestimated chronic complications are the negative effects of diabetes on bone health. Typical well known skeletal complications of poorly controlled diabetes mellitus include the diabetic foot syndrome and Charcot neuroarthropathy. However diabetes mellitus is also associated with an increased risk of osteoporosis and fragility fractures. The mechanisms underlying low bone strength in diabetes mellitus are not well understood. While high glucose itself has been reported to induce premature senescence in mesenchymal stem cells (MSC), we have demonstrated that glucose may also positively affect proliferation and differentiation of MSC. Type 1 diabetes mellitus (T1DM) affects the skeleton more severely than type 2 diabetes mellitus (T2DM), probably because of the lack of the bone anabolic actions of insulin. Also, diabetic nephropathy and reduced mobility may contribute to diabetic bone disease. It is important to note that a normal or even high bone mass in diabetic patients may not protect against fractures, because usually bone quality is impaired. In T2DM, oral thiazolidinedione treatment for hyperglycemia has further been associated with an elevated fracture risk. A physically active lifestyle and calcium and vitamin D repletion are effective as a therapeutical basis for elevated fracture risk in patients with T1DM or T2DM. Taking into account BMD and other risk factors can help to identify patients who require more intense pharmaceutical therapy that should be individually tailored. All osteoporosis medications are effective in patients with diabetes mellitus. Increased awareness of osteoporosis associated elevated fracture risk is needed in patients with diabetes mellitus.