Sweet Bones: The Effect of Dıabetes Mellıtus on Bone Health

Öz

Diabetes mellitus is a chronic hyperglycemic, common disease with significant mortality and morbidity affecting millions of people worldwide. Besides the well-known complications of diabetes on the cardiovascular system, eyes, kidneys and nervous system, bone is also affected by diabetes. Recently, there is increasing evidence that diabetes affects the skeletal system negatively and has harmful effects on bone, such as impaired bone quality and bone strength, increased risk of fractures and impaired bone healing. Diabetes has a strong impact on bone health, and skeletal fragility is now recognized as a major complication of both Type 1 and Type 2 diabetes. Decrease in bone mineral density in Type 1 diabetes, and deterioration in bone quality and strength, although bone density is normal or higher in Type 2 diabetes, increases the risk of fracture. In the late stages of Type 1 and Type 2 diabetes, insulin deficiency, insufficient release of insulin-like growth factor 1 can disrupt bone homeostasis and lead to fragility. Pathophysiological mechanisms that lead to bone fragility are multifactorial and potentially lead to impaired bone formation, altered bone structure, and reduced bone strength. Interestingly, different antidiabetic treatments can affect fracture risk due to glycemic control, triggering of hypoglycemic events, and effects on bone formation. In this review, the effect of diabetes on bone homeostasis, fracture risk, and the effect of antidiabetic therapy on bone recommendations to healthcare professionals are discussed.

Anahtar Kelimeler

• Bone fractures
• diabetes
• diabetic complications

Tatlı Kemikler: Diabetes Mellitus’un Kemik Sağlığına Etkisi

Öz

Diabetes mellitus, dünya çapında milyonlarca nüfusu etkileyen, önemli mortalite ve morbiditeye sahip, kronik hiperglisemik, yaygın bir hastalıktır. Diyabetin kardiyovasküler sistem, göz, böbrek ve sinir sistemi üzerinde iyi bilinen komplikasyonlarının yanı sıra iskelet sistemide diyabetten etkilenir. Son zamanlarda diyabetin iskelet sistemini olumsuz etkilediği, kemik kalitesinde ve kemik gücünde bozulma, artan kırık riski ve bozulmuş kemik iyileşmesi gibi kemik üzerine zararlı etkilerinin olduğunu gösteren kanıtlar artmaktadır. Diyabetin kemik sağlığı üzerinde güçlü bir etkisi vardır ve iskelet kırılganlığı artık hem Tip 1 hem de Tip 2 diyabetin önemli bir komplikasyonu olarak kabul edilmektedir. Tip 1 diyabette kemik mineral yoğunluğunun azalması, Tip 2 diyabette ise kemik yoğunluğunun normal hatta daha yüksek olmasına rağmen, kemik kalitesinin ve gücünün bozulması kırık riskini artırır. Tip 1 ve Tip 2 diyabetin geç aşamalarında, insülin eksikliği, insülin benzeri büyüme faktörü 1’in yetersiz salınımı kemik homeostazını bozarak kırılganlığa yol açabilir. Kemik kırılganlığına yol açan patofizyolojik mekanizmalar çok faktörlüdür ve potansiyel olarak kemik oluşumunun bozulmasına, kemik yapısının değişmesine ve kemik gücünün azalmasına yol açar. İlginç bir şekilde farklı antidiyabetik tedaviler, glisemik kontrol, hipoglisemik olayların tetiklenmesi, kemik oluşumu üzerindeki etkileri nedeniyle kırık riskini etkileyebilir. Bu derlemede, diyabetin kemik homeostazına etkisi, kırık riski, antidiyabetik tedavinin kemik üzerine etkisi ve sağlık personeline öneriler tartışılmaktadır.

Anahtar Kelimeler

• Diyabet
• diyabetik komplikasyonlar
• kemik kırıkları

Kaynakça

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