title: Diabetes and bone: biological and environmental factors.
abstract: OBJECTIVE
  Type 1 and type 2 diabetes mellitus are known to increase fracture risk. It is known that type 1 diabetes mellitus is associated with lower bone mineral density, but for type 2 diabetes mellitus, the real risk of increasing osteoporotic fractures is not explained by bone mineral density, which was found to be normal or paradoxically higher than controls in several studies, thus claiming for further investigations. This review summarizes some of the newest findings about factors that contribute to bone alterations in diabetic patients.
  
  
  RESULTS
  Most recent evidences showed that bone of diabetic patients presents a cortical porosity which is not captured by the bidimensional densitometric measurements as performed by dual energy X-ray absorptiometry. Other studies investigated bone matrix searching for molecular mechanisms underlying the reduced bone strength in diabetic patients. The loss of bone biomechanical properties in diabetes has been associated to the glycated collagen matrix induced by hyperglycemia. Other studies analyzed the effect on bone microarchitecture of the most common antidiabetic drugs.
  
  
  CONCLUSIONS
  Disease management of fracture risk in diabetic patients needs new methodologies of assessment that also take into account bone quality and evaluation of clinical risk factors, including balance, visual, and neurological impairments.
authors.affiliation: aIOS, Southern Italy Hospital Institute bColeman Ltd, Naples, cISBEM, Euro Mediterranean Scientific Biomedical Institute, Brindisi and Naples dUniversity Federico II, Naples, Italy.
authors.forename: Prisco
authors.initials: P
authors.lastname: Piscitelli
authors.forename: Cosimo
authors.initials: C
authors.lastname: Neglia
authors.forename: Antonella
authors.initials: A
authors.lastname: Vigilanza
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
mesh_terms: D015519:Bone Density; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004777:Environment; D006801:Humans; D010024:Osteoporosis / Q000209:etiology; D058866:Osteoporotic Fractures / Q000209:etiology*; D012306:Risk