Low-energy fractures — a new complication of type 2 diabetes?

Abstract

Low bone mineral density has traditionally been linked with type 1 diabetes. Latest research has confirmed that type 2 diabetics have increased fracture risk, whereas their bone mineral density is normal or increased when compared to healthy peers. It seems the assessment of bone mineral density using DXA (dual X-ray absorptiometry) does not reflect the complexity of bone pathology in diabetes, which has recently been the subject of debate. Increase in fracture risk is probably related to i.a. disease duration, metabolic disease, presence of complications, type of therapy, the increased susceptibility to falls. The underlying mechanism whereby diabetes type 2 exerts its detrimental effect on bone health is still not clear and often described as poor bone quality. This might be due to the accumulation of advanced glycation end products in bone, abnormal collagen cross-linking, accompanied by low rate of bone turnover. It was also shown that patients with diabetes have impaired structural and geometrical bone parameters. In light of increasing fracture incidence in postmenopausal women, fracture risk calculation is indicated also among older patients with type 2 diabetes.