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Type 1 diabetes and osteoporosis: A review of literature.

Dhaon P, Shah VN - Indian J Endocrinol Metab (2014)

Bottom Line: With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM).A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis.Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, King George Medical University, Lucknow, Uttar Pradesh, India.

ABSTRACT
With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM). Therefore, there is a need to change the focus from microvascular complications to cardiovascular disease and osteoporosis. Though number of studies from other parts of the world show that patients with T1DM are at increased risk of osteoporosis and fractures, there is a paucity of data from India. A number of factors and mechanisms affecting bone health in patients with T1DM have been proposed. The main defect in genesis of osteoporosis is osteoblastic function, rather than osteoclastic overfunction. Assessment of bone mineral density by dual X-ray absorptiometry and other risk factors for osteoporosis, as a part of diagnostic procedure can help to design tailored treatment plans. A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis. Treatment of osteoporosis is not evidence based but it is proposed to be similar to osteoporosis associated with other conditions. Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM. However, more studies are needed to make definitive guidelines on prevention and treatment of osteoporosis in patients with T1DM.

No MeSH data available.


Related in: MedlinePlus

Potential mechanisms leading to osteoporosis in patients with T1DM
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Figure 1: Potential mechanisms leading to osteoporosis in patients with T1DM

Mentions: T1DM is characterized by autoimmune destruction of beta cells resulting in near complete deficiency of insulin causing hyperglycemia.[6] Hyperglycemia affects the bone development in various ways; (1) it damages osteoblast either by osmotic damage or by suppressing gene expression responsible for osteoblast maturation.[43](2) it increases PPARγ that promote adipogenesis from mesenchymal stem cells at the expense of bone formation thus reducing bone accrual and peak bone mass.[4445] Glitazones, like pioglitazone, are agonists of PPARγ and they are linked to more fractures and low bone mass.[4647](3) The mice model and in vitro studies showed that hyperglycemia directly inhibits the bone formation as shown by expression of transcription factor RUNX2, biochemical markers and histomorphometric analysis.[4849](4) hyperglycemia also induces the expression of proinflammatory cytokines like TNFα which inhibits osteoblast differentiation and activity, thus increasing osteoblastic apoptosis.[5051](5) hyperglycemia may results in the generation of increase reactive oxygen species which in turn can increase osteoclast formation and activity.[52](6) Chronic hyperglycemia leads to development of microvascular complication like retinopathy, neuropathy and nephropathy.[53] Advance retinopathy increases the risk of fall by impairing vision which is further aggravated by the presence of diabetic neuropathy. Additionally, nephropathy can result in increase in protein loss which aggravates osteoporosis in patients with diabetes.[215455][Figure 1]


Type 1 diabetes and osteoporosis: A review of literature.

Dhaon P, Shah VN - Indian J Endocrinol Metab (2014)

Potential mechanisms leading to osteoporosis in patients with T1DM
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3987264&req=5

Figure 1: Potential mechanisms leading to osteoporosis in patients with T1DM
Mentions: T1DM is characterized by autoimmune destruction of beta cells resulting in near complete deficiency of insulin causing hyperglycemia.[6] Hyperglycemia affects the bone development in various ways; (1) it damages osteoblast either by osmotic damage or by suppressing gene expression responsible for osteoblast maturation.[43](2) it increases PPARγ that promote adipogenesis from mesenchymal stem cells at the expense of bone formation thus reducing bone accrual and peak bone mass.[4445] Glitazones, like pioglitazone, are agonists of PPARγ and they are linked to more fractures and low bone mass.[4647](3) The mice model and in vitro studies showed that hyperglycemia directly inhibits the bone formation as shown by expression of transcription factor RUNX2, biochemical markers and histomorphometric analysis.[4849](4) hyperglycemia also induces the expression of proinflammatory cytokines like TNFα which inhibits osteoblast differentiation and activity, thus increasing osteoblastic apoptosis.[5051](5) hyperglycemia may results in the generation of increase reactive oxygen species which in turn can increase osteoclast formation and activity.[52](6) Chronic hyperglycemia leads to development of microvascular complication like retinopathy, neuropathy and nephropathy.[53] Advance retinopathy increases the risk of fall by impairing vision which is further aggravated by the presence of diabetic neuropathy. Additionally, nephropathy can result in increase in protein loss which aggravates osteoporosis in patients with diabetes.[215455][Figure 1]

Bottom Line: With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM).A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis.Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, King George Medical University, Lucknow, Uttar Pradesh, India.

ABSTRACT
With better care and intensive insulin therapy, microvascular complications have reduced and longevity has increased in patients with type 1 diabetes (T1DM). Therefore, there is a need to change the focus from microvascular complications to cardiovascular disease and osteoporosis. Though number of studies from other parts of the world show that patients with T1DM are at increased risk of osteoporosis and fractures, there is a paucity of data from India. A number of factors and mechanisms affecting bone health in patients with T1DM have been proposed. The main defect in genesis of osteoporosis is osteoblastic function, rather than osteoclastic overfunction. Assessment of bone mineral density by dual X-ray absorptiometry and other risk factors for osteoporosis, as a part of diagnostic procedure can help to design tailored treatment plans. A physically active healthy lifestyle, prevention of diabetic complications and adequate calcium and vitamin D supplementation are the mainstay for prevention of osteoporosis. Treatment of osteoporosis is not evidence based but it is proposed to be similar to osteoporosis associated with other conditions. Bisphosphonates are the mainstay for treatment of osteoporosis in patients with T1DM. However, more studies are needed to make definitive guidelines on prevention and treatment of osteoporosis in patients with T1DM.

No MeSH data available.


Related in: MedlinePlus