糖尿病和骨质疏松的潜在机制

Q4 Medicine US endocrinology Pub Date : 2018-01-01 DOI:10.17925/USE.2018.14.2.65
Oscar Rosero Olarte, M. A. Andrade
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引用次数: 0

摘要

几项研究表明,糖尿病与骨折风险增加有关。双能x线骨密度测量显示,1型糖尿病患者骨密度较低,2型糖尿病患者骨折风险增加,尽管骨密度正常或较高。在糖尿病患者骨病的病理生理机制中提出了不同的机制。其机制包括微血管改变、晚期糖基化终产物积累、成骨细胞-破骨细胞功能改变(硬化蛋白增加、胰岛素样生长因子1 (IGF1)减少、骨钙素减少和其他分子改变),从而导致骨转换减少和骨质量改变。其他因素,如与糖尿病神经病变和糖尿病视网膜病变相关的跌倒风险增加也被提出。由于双x线骨密度测量法测量的骨密度与糖尿病患者骨折风险之间缺乏相关性,对糖尿病患者骨病的研究采用了不同的诊断方法。这些方法包括骨转换标志物的评估、FRAX评分、骨小梁评分以及高分辨率周围定量断层扫描的微结构评估。这篇社论简要概述了糖尿病和骨质疏松症之间的潜在机制,以及用于评估这些患者的诊断方法。
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Underlying Mechanisms Between Diabetes Mellitus and Osteoporosis
Several studies have linked diabetes mellitus with an increased risk of bone fractures. Patients with type 1 diabetes have lower bone mineral density and patients with type 2 diabetes have an increased risk of fracture despite normal or high bone mineral density, measured by dual energy x-ray absorptiometry. Different mechanisms have been proposed in the pathophysiology of bone disease in diabetic patients. The mechanisms involved include microvasculature changes, advanced glycation end products accumulation, and altered osteoblast–osteoclast function with increased sclerostin, decreased insulin-like growth factor 1 (IGF1), decreased osteocalcin, and other molecular alterations, leading to a decrease in bone turnover and altered bone quality. Other factors, such as increased risk of falls related to diabetic neuropathy and diabetic retinopathy have also been proposed. Different diagnostic methods have been described for the study of bone disease in patients with diabetes, due to the lack of correlation between bone mineral density measured by dual x-ray absorptiometry and the fracture risk in this group of patients. These methods include the evaluation of bone turnover markers, the FRAX score, the trabecular bone score, and the evaluation of microarchitecture with high-resolution peripheral quantitative tomography. This editorial provides a short overview of the underlying mechanisms between diabetes mellitus and osteoporosis, and the diagnostic methods used to evaluate these patients.
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来源期刊
US endocrinology
US endocrinology Medicine-Endocrinology, Diabetes and Metabolism
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1.90
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