Kumeda Yasuro
Jyurakukai Ohno Memorial Hospital, Department of Kidney Internal Medicine.
Clin Calcium. 2008 May;18(5):589-99.
The diabetes is at great risk of the osteoporosis, and the bone fragility unrelated to bone density forms the pathological conditions peculiar to diabetes. The factor participating in diabetic osteoporosis has a state of insulin action deficiency, a hyperglycemic state, diabetic complications, and so on. An osteoblastic cell function is deteriorated and the number of that is decreased by the absolute and relative insulin deficiency, and sustained hyperglycemia also decreases an osteoblastic cell function still more. Furthermore, the osteoclast-related bone resorption is also promoted through sorbitol accumulation in the cell by the hyperglycemia state. The expression of transcription factors regulating osteoblastic cell differentiation is restrained, and the apoptosis of those cells is promoted. As a result, osteoplasty is obstructed. In the bone, AGEs (advanced glycation endproducts) is produced in excess, and bone fragility is promoted by the ratio of the AGEs bridging with the collagen rising. The complications of diabetes, such as visual disorder and the neuropathy, raise the risk of the fall in the diabetic osteoporosis patient, therefore, they will have more chance of fractures.
糖尿病患者患骨质疏松症的风险很高，与骨密度无关的骨脆性构成了糖尿病特有的病理状况。参与糖尿病性骨质疏松症的因素包括胰岛素作用缺陷状态、高血糖状态、糖尿病并发症等。绝对和相对胰岛素缺乏会使成骨细胞功能恶化且数量减少，持续高血糖还会进一步降低成骨细胞功能。此外，高血糖状态通过细胞内山梨醇积累也促进了破骨细胞相关的骨吸收。调节成骨细胞分化的转录因子表达受到抑制，这些细胞的凋亡被促进。结果，骨形成受到阻碍。在骨骼中，晚期糖基化终产物（AGEs）过度产生，与胶原蛋白交联的AGEs比例升高促进了骨脆性。糖尿病并发症，如视力障碍和神经病变，增加了糖尿病性骨质疏松症患者跌倒的风险，因此，他们骨折的几率更高。
