Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
Curr Osteoporos Rep. 2020 Aug;18(4):371-377. doi: 10.1007/s11914-020-00598-z.
To provide an update on the acute effects of glucose, insulin, and incretins on markers of bone turnover in those with and without diabetes.
Bone resorption is suppressed acutely in response to glucose and insulin challenges in both healthy subjects and patients with diabetes. The suppression is stronger with oral glucose compared with intravenous delivery. Stronger responses with oral glucose may be related to incretin effects on insulin secretion or from a direct effect on bone turnover. Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-2 (GLP-2) infusion acutely suppresses bone resorption without much effect on bone formation. The bone turnover response to a metabolic challenge may be attenuated in type 2 diabetes, but this is an understudied area. A knowledge gap exists regarding bone turnover responses to a metabolic challenge in type 1 diabetes. The gut-pancreas-bone link is potentially an endocrine axis. This linkage is disrupted in diabetes, but the mechanism and progression of this disruption are not understood.
提供糖尿病和非糖尿病患者中葡萄糖、胰岛素和肠促胰岛素对骨转换标志物的急性作用的最新进展。
健康受试者和糖尿病患者的葡萄糖和胰岛素挑战均可抑制骨吸收。与静脉内给药相比，口服葡萄糖的抑制作用更强。口服葡萄糖的反应更强可能与肠促胰岛素对胰岛素分泌的影响有关，也可能与对骨转换的直接作用有关。葡萄糖依赖性胰岛素释放肽（GIP）和胰高血糖素样肽-2（GLP-2）输注可急性抑制骨吸收，对骨形成影响不大。代谢挑战对 2 型糖尿病患者的骨转换反应可能减弱，但这是一个研究不足的领域。在 1 型糖尿病中，代谢挑战对骨转换反应的知识空白仍然存在。肠道-胰腺-骨骼的联系可能是一个内分泌轴。这种联系在糖尿病中被打破，但机制和进展尚不清楚。
