Tell-Lebanon Osnat, Rotman-Pikielny Pnina
Department of Family Medicine, Clalit Health Service, Israel.
Metabolic Bone Disease Service, Endocrine Institute, Meir Medical Center, Kfar Saba, Israel.
Harefuah. 2016 Nov;155(11):697-701.
Diabetes and osteoporosis are common diseases with growing prevalence in the aging population. Many recent studies have reported an association between diabetes mellitus and an increased osteoporotic fracture rate. Compared to control subjects, decreased bone mineral density has been observed in patients with type 1 diabetes mellitus, while those with type 2 diabetes display a unique skeletal phenotype of increased bone mineral density, but impaired architectural structure and mineral properties. Accumulation of advanced glycation end products changes collagen structure and suppression of bone turnover causes impairment of repair and adaptation mechanisms. These seem to be significant factors impairing bone strength. In addition, longer disease duration, disease complications, insulin use and increased falls, as well as the use of drugs like thiazolidinediones for treatment, are all reported risk factors for fractures among patients with diabetes. Conventional diagnostic tools, including DXA measurements and the fracture risk assessment (FRAX) tool, seem to underestimate fracture risk so that for every FRAX, the actual risk of fracture is higher in the diabetic patient. Despite the unique pathophysiology of bone disease in patients with diabetes, as far as we know, existing drug treatments for osteoporosis are as effective as in patients without diabetes. Therefore, physicians should be aware of the higher risk for osteoporotic fracture among patients with diabetes and treat them according to the clinical algorithms used for all patients.
糖尿病和骨质疏松症是老龄化人群中患病率不断上升的常见疾病。最近许多研究报告了糖尿病与骨质疏松性骨折发生率增加之间的关联。与对照组相比，1型糖尿病患者的骨矿物质密度降低，而2型糖尿病患者表现出独特的骨骼表型，即骨矿物质密度增加，但结构和矿物质特性受损。晚期糖基化终末产物的积累改变了胶原蛋白结构，骨转换的抑制导致修复和适应机制受损。这些似乎是损害骨强度的重要因素。此外，病程延长、疾病并发症、胰岛素使用和跌倒增加，以及使用噻唑烷二酮类药物进行治疗等，均被报告为糖尿病患者骨折的危险因素。包括双能X线吸收法测量和骨折风险评估（FRAX）工具在内的传统诊断工具似乎低估了骨折风险，以至于对于每一个FRAX，糖尿病患者的实际骨折风险更高。尽管糖尿病患者的骨病具有独特的病理生理学，但据我们所知，现有的骨质疏松症药物治疗在糖尿病患者中的效果与非糖尿病患者相同。因此，医生应意识到糖尿病患者发生骨质疏松性骨折的风险更高，并根据用于所有患者的临床算法对他们进行治疗。
