Type 2 Diabetes and Bone Disease

• Published in: Clinical reviews in bone and mineral metabolism 2023-12, Vol.21 (1-4), p.21-31
• Main Authors: Lopez, Norma, Cohen, Sara M., Emanuele, Maryann
• Format: Article
• Language: English
• Subjects: Endocrinology; Gynecology; Internal Medicine; Medicine; Medicine & Public Health; Orthopedics; Review Article; Rheumatology
• ISSN: 1559-0119; 1559-0119
• DOI: 10.1007/s12018-023-09288-7

Diabetes and osteoporosis are age-related conditions contributing to the burgeoning burden of health care as life expectancy increases. Over the past 30 years, evidence has emerged indicating that these two conditions are related. Diabetes is well recognized to affect bone health, contributing to decreased bone formation, increased bone marrow adiposity, and heightened risk of fracture. Age-related inflammation and oxidative stress promote the development of osteoporosis primarily by reducing bone formation, and they are augmented in diabetes. There is an association between reduced bone remodeling and increased incidence of type 2 diabetes mellitus (T2DM). Although both men and women are affected, more research on this relationship has been conducted in older women, likely due to a higher burden of disease. Mounting evidence demonstrates the influence of bone remodeling on glucose regulation via bone-derived factors. These factors include fibroblast growth factor 23 (FGF-23) and osteocalcin, which affect pancreatic beta cell proliferation; insulin expression and secretion; and storage and release of glucose from the liver, skeletal muscle, and adipose tissue. This review will highlight the inter-connectivity of diabetes and osteoporosis, focusing on the clinical relevance of diagnosing and treating bone loss early and appropriately in individuals with diabetes.