NUTRIM Research School, Maastricht University, Maastricht, The Netherlands.
Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands; CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
Maturitas. 2018 Mar;109:70-77. doi: 10.1016/j.maturitas.2017.12.011. Epub 2017 Dec 15.
Fracture risk in patients with type 2 diabetes mellitus (T2DM) is increased, and the mechanism is multifactorial. Recent research on T2DM-induced bone fragility shows that bone mineral density (BMD) is often normal or even slightly elevated. However, bone turnover may be decreased and bone material and microstructural properties are altered, especially when microvascular complications are present. Besides bone fragility, extra-skeletal factors leading to an increased propensity to experience falls may also contribute to the increased fracture risk in T2DM, such as peripheral neuropathy, retinopathy and diabetes medication (e.g. insulin use). One of the probable additional contributing factors to the increased fall and fracture risks in T2DM is sarcopenia, the age-related decline in skeletal muscle mass, quality and function. Although the association between sarcopenia, fall risk, and fracture risk has been studied in the general population, few studies have examined the association between T2DM and muscle tissue and the risks of falls and fractures. This narrative review provides an overview of the literature regarding the multifactorial mechanisms leading to increased fracture risk in patients with T2DM, with a focus on sarcopenia and falls.
2 型糖尿病（T2DM）患者的骨折风险增加，其机制是多因素的。最近关于 T2DM 引起的骨脆弱性的研究表明，骨密度（BMD）通常正常甚至略有升高。然而，骨转换可能减少，骨物质和微观结构特性发生改变，特别是在存在微血管并发症时。除了骨脆弱性外，导致跌倒倾向增加的骨骼外因素也可能导致 T2DM 骨折风险增加，如周围神经病变、视网膜病变和糖尿病药物（如胰岛素使用）。导致 T2DM 跌倒和骨折风险增加的另一个可能的附加因素是肌肉减少症，即与年龄相关的骨骼肌质量、质量和功能下降。尽管在一般人群中已经研究了肌肉减少症、跌倒风险和骨折风险之间的关联，但很少有研究检查 T2DM 与肌肉组织以及跌倒和骨折风险之间的关联。本综述概述了关于导致 T2DM 患者骨折风险增加的多种机制的文献，重点关注肌肉减少症和跌倒。
