Links among Obesity, Type 2 Diabetes Mellitus, and Osteoporosis: Bone as a Target.
Monika MartiniakovaRoman BiroNoemi PenzesAnna SarockaVeronika KovacovaVladimira MondockovaRadoslav OmelkaPublished in: International journal of molecular sciences (2024)
Obesity, type 2 diabetes mellitus (T2DM) and osteoporosis are serious diseases with an ever-increasing incidence that quite often coexist, especially in the elderly. Individuals with obesity and T2DM have impaired bone quality and an elevated risk of fragility fractures, despite higher and/or unchanged bone mineral density (BMD). The effect of obesity on fracture risk is site-specific, with reduced risk for several fractures (e.g., hip, pelvis, and wrist) and increased risk for others (e.g., humerus, ankle, upper leg, elbow, vertebrae, and rib). Patients with T2DM have a greater risk of hip, upper leg, foot, humerus, and total fractures. A chronic pro-inflammatory state, increased risk of falls, secondary complications, and pharmacotherapy can contribute to the pathophysiology of aforementioned fractures. Bisphosphonates and denosumab significantly reduced the risk of vertebral fractures in patients with both obesity and T2DM. Teriparatide significantly lowered non-vertebral fracture risk in T2DM subjects. It is important to recognize elevated fracture risk and osteoporosis in obese and T2DM patients, as they are currently considered low risk and tend to be underdiagnosed and undertreated. The implementation of better diagnostic tools, including trabecular bone score, lumbar spine BMD/body mass index (BMI) ratio, and microRNAs to predict bone fragility, could improve fracture prevention in this patient group.
Keyphrases
- bone mineral density
- postmenopausal women
- weight loss
- body composition
- metabolic syndrome
- insulin resistance
- weight gain
- glycemic control
- type diabetes
- body mass index
- high fat diet induced
- bariatric surgery
- end stage renal disease
- healthcare
- primary care
- risk factors
- newly diagnosed
- hip fracture
- peritoneal dialysis
- physical activity
- ejection fraction
- cardiovascular risk factors
- cardiovascular disease
- prognostic factors
- drug induced