title: Type 2 diabetes and bone fractures.
abstract: OBJECTIVE
  To discuss current literature and hypotheses pertaining to the pathophysiology of increased bone fragility and fracture in men and women with type 2 diabetes mellitus.
  
  
  RESULTS
  Despite high bone mineral density, studies have shown that men and women with type 2 diabetes mellitus (T2DM) are at increased risk for fracture. Complications of T2DM including retinopathy and autonomic dysfunction may contribute to bone fracture by increasing fall risk. Nephropathy may lead to renal osteodystrophy. Lean mass and potentially fat mass, may additionally contribute to skeletal health in diabetes. There is increasing acknowledgement that the marrow microenvironment is critical to efficient bone remodeling. Medications including thiazolidinediones and selective serotonin reuptake inhibitors may also impair bone remodeling by acting on mesenchymal stem cell differentiation and osteoblastogenesis. T2DM is associated with significant alterations in systemic inflammation, advanced glycation end-product accumulation and reactive oxygen species generation. These systemic changes may also directly and adversely impact the remodeling cycle and lead to bone fragility in T2DM, though more research is needed.
  
  
  CONCLUSIONS
  Fracture is a devastating event with dismal health consequences. Identifying the extrinsic and intrinsic biochemical causes of bone fracture in T2DM will speed the discovery of effective strategies for fracture prevention and treatment in this at-risk population.
authors.affiliation: Division of Endocrinology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA. kmosele4@jhmi.edu
authors.forename: Kendall F
authors.initials: KF
authors.lastname: Moseley
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015992:Body Mass Index; D015519:Bone Density; D016723:Bone Remodeling / Q000187:drug effects*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D045162:Thiazolidinediones / Q000009:adverse effects
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones