Khan Tayyab S, Fraser Lisa-Ann
Department of Medicine, Western University, London, ON, Canada.
Department of Medicine, Western University, London, ON, Canada ; Division of Endocrinology and Metabolism, St. Joseph's Health Care, 268 Grosvenor Street, London, ON, Canada N6A 4V2.
J Osteoporos. 2015;2015:174186. doi: 10.1155/2015/174186. Epub 2015 Mar 22.
The link between type 1 diabetes mellitus (DM1) and osteoporosis, identified decades ago, has gained attention in recent years. While a number of cellular mechanisms have been postulated to mediate this association, it is now established that defects in osteoblast differentiation and activity are the main culprits underlying bone fragility in DM1. Other contributing factors include an accumulation of advanced glycation end products (AGEs) and the development of diabetes complications (such as neuropathy and hypoglycemia), which cause further decline in bone mineral density (BMD), worsening geometric properties within bone, and increased fall risk. As a result, patients with DM1 have a 6.9-fold increased incidence of hip fracture compared to controls. Despite this increased fracture risk, bone fragility remains an underappreciated complication of DM1 and is not addressed in most diabetes guidelines. There is also a lack of data regarding the efficacy of therapeutic strategies to treat osteoporosis in this patient population. Together, our current understanding of bone fragility in DM1 calls for an update of diabetes guidelines, better screening tools, and further research into the use of therapeutic strategies in this patient population.
1型糖尿病（DM1）与骨质疏松症之间的联系早在数十年前就已被发现，近年来愈发受到关注。尽管人们推测了多种细胞机制来介导这种关联，但现在已经明确，成骨细胞分化和活性缺陷是DM1患者骨脆性的主要原因。其他促成因素包括晚期糖基化终末产物（AGEs）的积累以及糖尿病并发症（如神经病变和低血糖）的发生，这些会导致骨矿物质密度（BMD）进一步下降、骨骼内部几何特性恶化以及跌倒风险增加。因此，与对照组相比，DM1患者髋部骨折的发生率增加了6.9倍。尽管骨折风险增加，但骨脆性仍是DM1一种未得到充分重视的并发症，在大多数糖尿病指南中并未提及。此外，关于该患者群体治疗骨质疏松症的治疗策略疗效的数据也很缺乏。总体而言，我们目前对DM1患者骨脆性的理解要求更新糖尿病指南、改进筛查工具，并进一步研究针对该患者群体的治疗策略。
