Review
Copyright ©The Author(s) 2021.
World J Diabetes. Jun 15, 2021; 12(6): 706-729
Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.706
Figure 1
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Figure 1 Mechanisms of increased bone fragility in type 1 diabetes mellitus. DKA: Diabetic ketoacidosis; IGF-1: Insulin-like growth factor; PPAR: Peroxisome proliferator-activated receptor; MSC: Mesenchymal stem cell;IL-1: Interleukin 1; TNF: Tumor necrosis factor.
Figure 2
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Figure 2 Mechanisms underlying bone fragility in type 2 diabetes mellitus. AGE: Advanced glycated end product; BMSi: Bone material strength index; CTX: C-terminal cross-linked telopeptide; GLP-1: Glucagon-like peptide-1; MSC: Mesenchymal stem cells; P1NP: Procollagen type 1 N-terminal propeptide; PTH: Parathyroid hormone; ROS: Reactive oxygen species; TRAP: Tartrate-resistant acid phosphatase.
Figure 3
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Figure 3 Algorithm for evaluation of bone health in type 1 diabetes mellitus. BMI: Body mass index; BMD-DXA: Bone mineral density by dual energy X-ray absorptiometry; F/U: Follow up; FRAX: Fracture Risk Assessment Tool; H/o: History of; T1DM: Type 1 diabetes mellitus; TBS: Trabecular bone score; VFA: Vertebral fracture assessment.
Figure 4
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Figure 4 Evaluation of fracture risk in patients with type 2 diabetes mellitus. 1: ≥ 1 nonvertebral nonhip fragility fracture might be required to initiate therapy; 2: Diabetes-specific clinical risk factors (diabetes duration, antidiabetic medications,, hemoglobin A1c and microvascular complications); 3: In diabetes, fracture risk at T-score < -2 equivalent for nondiabetes at T-score < -2.5; 4: See text. CRF: Clinical risk factor; TBS: Trabecular bone score; DXA: Dual energy X-ray absorptiometry; T2DM: Type 2 diabetes mellitus; FRAX: Fracture Risk Assessment Tool; H/o: History of. Modified from Ferrari et al[123]: Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, El-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD; Bone and Diabetes Working Group of IOF. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 2018; 29:2585-2596.Copyright ©The Author(s) 2018. Published by Springer Nature.
Figure 5
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Figure 5 Strategies for treating type 2 diabetes mellitus and concurrent osteoporosis. CKD-MBD: Chronic kidney disease–mineral and bone disorder; DPP-4i: Dipeptidyl-peptidase 4 inhibitor; GLP-1: Glucagon-like peptide-1; T2DM: Type 2 diabetes mellitus.