Psachna Stavroula, Chondrogianni Maria Eleni, Stathopoulos Konstantinos, Polymeris Antonis, Chatzigeorgiou Antonios, Chronopoulos Efstathios, Tournis Symeon, Kassi Eva
Laboratory for Research of the Musculoskeletal System, KAT Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Endocrinology, Metabolism and Diabetes Mellitus, Attica General Hospital "Sismanoglio-Amalia Fleming", Athens, Greece.
Endocrine. 2025 Mar;87(3):907-919. doi: 10.1007/s12020-024-04070-1. Epub 2024 Oct 15.
Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia, which derives from either insufficient insulin production [type 1 diabetes mellitus (T1DM)] or both impaired insulin sensitivity along with inadequate insulin production [type 2 diabetes mellitus (T2DM)] and affects millions of people worldwide. In addition to the adverse effects of DM on classical target organs and tissues, skeletal health can also be adversely affected. There is considerable evidence linking DM with osteoporosis. The fracture risk in patients with DM differs upon the type of diabetes, and it appears to be related to the type of anti-diabetic treatment. Antidiabetic drugs may have various effects on bone health. Most of them have neutral or even favorable effects on bone metabolism with the exception of thiazolidinediones (TZDs). Some studies suggest that TZDs may have negative impact on bone health by decreasing bone formation and increasing the fracture risk. There are also limited studies linking the use of canagliflozin, a Sodium-glucose contransporter-2 inhibitor (SGLT2i), with increased fracture risk. On the other hand, therapies that are based on incretin effect, like Dipeptidyl peptidase-4 inhibitors (DPP-4i) and Glucagon-like peptide-1 receptor agonizts (GLP-1RAs) might have positive effects on bone health by promoting bone formation. Herein we review the impact of antidiabetic drugs on bone health, highlighting the potential benefits and risks associated with these medications in an attempt to contribute to the development of personalized treatment strategies for individuals with DM.
糖尿病（DM）是一种复杂的代谢紊乱疾病，其特征为慢性高血糖，这源于胰岛素分泌不足[1型糖尿病（T1DM）]或胰岛素敏感性受损以及胰岛素分泌不足两者兼而有之[2型糖尿病（T2DM）]，全球数以百万计的人受其影响。除了糖尿病对经典靶器官和组织的不良影响外，骨骼健康也会受到不利影响。有大量证据表明糖尿病与骨质疏松症有关。糖尿病患者的骨折风险因糖尿病类型而异，并且似乎与抗糖尿病治疗的类型有关。抗糖尿病药物可能对骨骼健康有多种影响。除噻唑烷二酮类（TZDs）外，它们中的大多数对骨代谢具有中性甚至有利影响。一些研究表明，TZDs可能通过减少骨形成和增加骨折风险对骨骼健康产生负面影响。也有有限的研究将钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）卡格列净的使用与骨折风险增加联系起来。另一方面，基于肠促胰岛素效应的疗法，如二肽基肽酶-4抑制剂（DPP-4i）和胰高血糖素样肽-1受体激动剂（GLP-1RAs），可能通过促进骨形成对骨骼健康产生积极影响。在此，我们综述抗糖尿病药物对骨骼健康的影响，强调这些药物相关的潜在益处和风险，以期为糖尿病患者个性化治疗策略的制定做出贡献。
