Dicembrini Ilaria, Mannucci Edoardo, Rotella Carlo Maria
Section of Endocrinology, Department of Clinical Pathophysiology, Careggi Teaching Hospital, University of Florence and Obesity Agency, 50127 Florence, Italy.
Exp Diabetes Res. 2012;2012:519784. doi: 10.1155/2012/519784. Epub 2012 Jun 17.
Novel incretin-based drugs, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i), have been last introduced in the pharmacological treatment of type 2 diabetes. In the last few years, the interest on the relationship of gut hormones with bone metabolism in diabetes has been increasing. The aim of present paper is to examine in vitro and in vivo evidence on the connections between incretin hormones and bone metabolism. We also discuss results of clinical trials and metaanalysis, explore the effects of incretin drugs in vitro on osteogenic cells and osteoclasts, and speculate on the possibility of different effects of GLP-1 RA and DPP-4i on the risk of bone fractures risk in humans. Although existing preliminary evidence suggests a protective effect on the bone, at least for DPP-4i, further controlled, long-term studies with measurement of bone markers, bone density, and clinical fractures rates are needed to substantiate and confirm those findings.
新型肠促胰岛素类药物，如胰高血糖素样肽-1受体激动剂（GLP-1 RA）和二肽基肽酶-4抑制剂（DPP-4i），最近已被引入2型糖尿病的药物治疗中。在过去几年中，人们对糖尿病患者肠道激素与骨代谢之间关系的兴趣日益增加。本文的目的是研究肠促胰岛素激素与骨代谢之间联系的体外和体内证据。我们还将讨论临床试验和荟萃分析的结果，探讨肠促胰岛素药物在体外对成骨细胞和破骨细胞的影响，并推测GLP-1 RA和DPP-4i对人类骨折风险的不同影响。尽管现有初步证据表明对骨骼有保护作用，至少对DPP-4i是这样，但仍需要进一步进行有对照的长期研究，测量骨标志物、骨密度和临床骨折发生率，以证实和确认这些发现。
