title: Type 2 diabetes and the skeleton: new insights into sweet bones.
abstract: Substantial evidence shows that skeletal fragility should be considered among the complications associated with type 2 diabetes. Individuals with type 2 diabetes have increased fracture risk, despite normal bone mineral density (BMD) and high BMI-factors that are generally protective against fractures. The mechanisms underlying skeletal fragility in diabetes are not completely understood, but are multifactorial and likely include effects of obesity, hyperglycaemia, oxidative stress, and accumulation of advanced glycation end products, leading to altered bone metabolism, structure, and strength. Clinicians should be aware that BMD measurements underestimate fracture risk in people with type 2 diabetes, and that new treatments for diabetes, with neutral or positive effects on skeletal health, might play a part in the management of diabetes in those at high risk of fracture. Data for the optimum management of osteoporosis in patients with type 2 diabetes are scarce, but in the absence of evidence to the contrary, physicians should follow guidelines established for postmenopausal osteoporosis.
authors.affiliation: Department of Endocrinology, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense Denmark.
authors.forename: Vikram V
authors.initials: VV
authors.lastname: Shanbhogue
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Mitchell
authors.affiliation: Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Rosen
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. Electronic address: mbouxsei@bidmc.harvard.edu.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bouxsein
mesh_terms: D015519:Bone Density; D001847:Bone Diseases / Q000209:etiology* / Q000503:physiopathology; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D007004:Hypoglycemic Agents