Anastasilakis Athanasios D, Tsourdi Elena, Tabacco Gaia, Naciu Anda Mihaela, Napoli Nicola, Vescini Fabio, Palermo Andrea
Department of Endocrinology, 424 General Military Hospital, 56429 Thessaloniki, Greece.
Department of Medicine (III) &Center for Healthy Aging, Technische Universität Dresden Medical Center, 01307 Dresden, Germany.
J Clin Med. 2021 Mar 2;10(5):996. doi: 10.3390/jcm10050996.
Osteoporosis and diabetes mellitus represent global health problems due to their high, and increasing with aging, prevalence in the general population. Osteoporosis can be successfully treated with both antiresorptive and anabolic drugs. While these drugs are clearly effective in reducing the risk of fracture in patients with postmenopausal and male osteoporosis, it is still unclear whether they may have the same efficacy in patients with diabetic osteopathy. Furthermore, as bone-derived cytokines (osteokines) are able to influence glucose metabolism, it is conceivable that antiosteoporotic drugs may have an effect on glycemic control through their modulation of bone turnover that affects the osteokines' release. These aspects are addressed in this narrative review by means of an unrestricted computerized literature search in the PubMed database. Our findings indicate a balance between good and bad news. Active bone therapies and their modulation of bone turnover do not appear to play a clinically significant role in glucose metabolism in humans. Moreover, there are insufficient data to clarify whether there are any differences in the efficacy of antiosteoporotic drugs on fracture incidence between diabetic and nondiabetic patients with osteoporosis. Although more studies are required for stronger recommendations to be issued, bisphosphonates appear to be the first-line drug for treatment of osteoporosis in diabetic patients, while denosumab seems preferable for older patients, particularly for those with impaired renal function, and osteoanabolic agents should be reserved for patients with more severe forms of osteoporosis.
骨质疏松症和糖尿病是全球性的健康问题，因为它们在普通人群中的患病率很高，且随着年龄增长而增加。抗吸收药物和促合成药物均可成功治疗骨质疏松症。虽然这些药物在降低绝经后骨质疏松症患者和男性骨质疏松症患者的骨折风险方面显然有效，但它们在糖尿病性骨病患者中是否具有相同疗效仍不清楚。此外，由于骨源性细胞因子（骨动蛋白）能够影响葡萄糖代谢，可以想象抗骨质疏松药物可能通过调节影响骨动蛋白释放的骨转换来影响血糖控制。本叙述性综述通过在PubMed数据库中进行无限制的计算机文献检索来探讨这些方面。我们的研究结果显示了好坏消息之间的平衡。积极的骨治疗及其对骨转换的调节似乎在人类葡萄糖代谢中未发挥临床显著作用。此外，尚无足够数据阐明抗骨质疏松药物在糖尿病和非糖尿病骨质疏松症患者骨折发生率方面的疗效是否存在差异。尽管需要更多研究才能给出更强有力的建议，但双膦酸盐似乎是糖尿病患者骨质疏松症治疗的一线药物，而地诺单抗似乎更适合老年患者，特别是肾功能受损的患者，骨促合成药物应保留给患有更严重骨质疏松症的患者。
