Almutlaq Nourah, Neyman Anna, DiMeglio Linda A
Division of Pediatric Endocrinology and Diabetology.
Wells Center for Pediatric Research, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
Curr Opin Endocrinol Diabetes Obes. 2021 Aug 1;28(4):354-359. doi: 10.1097/MED.0000000000000642.
We describe relationships between microvascular complications and bone fragility fracture in the context of diabetes. We highlight gaps in knowledge and suggest areas of further study.
Evidence in type 1 diabetes (T1D) demonstrates that low bone mineral density (BMD) is associated with microvascular complications and linked to increased fracture risk. Of note, the low BMD does not solely explain bone fragility. Microvascular disease also has been linked to compromised bone microarchitecture and poorer bone quality. Moreover, microvascular complications may indirectly increase the rate of fragility fracture through increasing fall propensity; however, to date no conclusive studies have assessed microvascular disease and fracture risk independent of falls.In the other hand, individuals with type 2 diabetes (T2D) have increased fracture risk despite high BMD. Data suggest microvascular disease mediates microarchitectural changes by increasing cortical porosity and is associated with lower bone turnover. There is no direct evidence linking microangiopathy to fracture incidence.
Taken together present evidence suggests associations between diabetic bone disease, fragility fracture, and microvascular disease. Data are more convincing for T1D than T2D. Further studies are required to confirm whether microvascular disease is itself causative of fracture or merely a contributory factor to fragility fracture for persons with diabetes.
我们描述了糖尿病背景下微血管并发症与骨脆性骨折之间的关系。我们强调了知识空白并提出了进一步研究的领域。
1型糖尿病（T1D）的证据表明，低骨矿物质密度（BMD）与微血管并发症相关，并与骨折风险增加有关。值得注意的是，低骨密度并不能完全解释骨脆性。微血管疾病还与骨微结构受损和较差的骨质量有关。此外，微血管并发症可能通过增加跌倒倾向间接增加脆性骨折的发生率；然而，迄今为止，尚无确凿研究评估独立于跌倒因素的微血管疾病与骨折风险之间的关系。另一方面，2型糖尿病（T2D）患者尽管骨密度高，但骨折风险增加。数据表明，微血管疾病通过增加皮质骨孔隙率介导骨微结构变化，并与较低的骨转换率相关。没有直接证据表明微血管病变与骨折发生率有关。
综合现有证据表明，糖尿病性骨病、脆性骨折和微血管疾病之间存在关联。对于T1D的数据比T2D更有说服力。需要进一步研究以确认微血管疾病本身是否是骨折的病因，还是仅仅是糖尿病患者脆性骨折的一个促成因素。
