Hygum Katrine, Starup-Linde Jakob, Langdahl Bente L
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Osteoporos Sarcopenia. 2019 Jun;5(2):29-37. doi: 10.1016/j.afos.2019.05.001. Epub 2019 May 15.
Bone disease is a serious complication to diabetes. Patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) suffer from an increased risk of fracture, most notably at the hip, compared with patients without diabetes. Confounders such as patient sex, age, body mass index, blood glucose status, fall risk, and diabetes medications may influence the fracture risk. Different underlying mechanisms contribute to bone disease in patients with diabetes. Bone quality is affected by low bone turnover in T1D and T2D, and furthermore, incorporation of advanced glycation end-products, changes in the incretin hormone response, and microvascular complications contribute to impaired bone quality and increased fracture risk. Diagnosis of bone disease in patients with diabetes is a challenge as current methods for fracture prediction such as bone mineral density T-score and fracture risk assessment tools underestimate fracture risk for patients with T1D and T2D. This review focuses on bone disease and fracture risk in patients with diabetes regarding epidemiology, underlying disease mechanisms, and diagnostic methods, and we also provide considerations regarding the management of diabetes patients with bone disease in terms of an intervention threshold and different treatments.
骨病是糖尿病的一种严重并发症。与非糖尿病患者相比，1型糖尿病（T1D）和2型糖尿病（T2D）患者发生骨折的风险增加，最明显的是髋部骨折。患者性别、年龄、体重指数、血糖状况、跌倒风险和糖尿病药物等混杂因素可能影响骨折风险。不同的潜在机制导致糖尿病患者发生骨病。T1D和T2D患者的低骨转换会影响骨质量，此外，晚期糖基化终产物的掺入、肠促胰岛素激素反应的变化以及微血管并发症都会导致骨质量受损和骨折风险增加。糖尿病患者的骨病诊断具有挑战性，因为目前的骨折预测方法，如骨密度T值和骨折风险评估工具，会低估T1D和T2D患者的骨折风险。本综述重点关注糖尿病患者的骨病和骨折风险，包括流行病学、潜在疾病机制和诊断方法，我们还从干预阈值和不同治疗方法的角度，对糖尿病骨病患者的管理提供了一些考虑。
