Diabetes Drug Effects on the Skeleton

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• 作者：Manju Chandran
• 关键词：Diabetes ; Fracture ; BMD ; Anti ; diabetes treatment ; Bone turnover markers ; Diabetes drugs ; Bone
• 刊名：Calcified Tissue International
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：100
• 期：2
• 页码：133-149
• 全文大小：
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biochemistry, general; Endocrinology; Orthopedics; Cell Biology;
• 出版者：Springer US
• ISSN：1432-0827
• 卷排序：100

文摘

Diabetes be it type 1 or type 2 is associated with an increased risk of fragility fractures. The mechanisms underlying this increased risk are just being elucidated. Anti-diabetes medications are crucial for maintaining glucose control and for preventing micro- and macrovascular complications in diabetes. However, they may modulate fracture risk in diabetes in different ways. Thiazolidinediones have demonstrated an unfavorable effect on the skeleton, while metformin and sulfonylureas may have a neutral if not beneficial effect on bone. The use of insulin has been associated with an increased risk of fragility fractures though it is not clear whether it is due to direct influence of insulin or whether it is mediated through hypoglycemia and increased falls risk. The overall effect of incretin mimetics appears to be beneficial; however, this has to be elucidated further. The bone effects of pramlintide, a synthetic analog of amylin, have not been explored fully. Finally, issues regarding bone safety of SGLT2 (sodium-dependent glucose transporter 2) inhibitors, the newest anti-diabetic medications on the market are of concern. The purpose of this review is to provide a comprehensive overview of the effect of these medications on bone metabolism and the studies exploring the risk or lack thereof of these medications on bone loss and fragility fractures.