Post on 17-Feb-2019
Diabete e resistenza ossea: quale legame?
P. D’Amelio MD, PhDGeriatria e Malattie Metaboliche
dell’Osso – Dipartimento di Scienze Mediche – Università di Torino
61° CONGRESSO NAZIONALE SIGG“Stiamo lavorando per farti invecchiare
meglio”: simposio SIGG-SIOMMMS
Napoli, 2 Dicembre 2013
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cellsObesity
Fragility fracture incidence
8.9 milion/yr fractures in the world (1)
1,000 fractures/hr in the world (1)
1/3 of fragility fractures occur in Europe (1)
465,000 /yr nwe fractures in Italy (2)
1. Hernlund E. et al.; Arch Osteoporos 2013; 8: 136; 2. Svedbom A. et al.; Arch Osteoporos 2013; 8: 317
The number of fractures/yrs is increasing (2)
Mohsen Janghorbani et al. Am. J. Epidemiol. 2007
Diabetic patients (T2DM) have increasedrisk of fractures (1)
Strotmeyer ES et al. Arch Intern Med. 2005
Diabetic patients (T2DM) have increasedrisk of fractures (2)
Mohsen Janghorbani et al. Am. J. Epidemiol. 2007
Diabetic patients (T1DM) have increasedrisk of fractures (3)
Factors leading to fractures in diabetics
DM 1 DM2
Increased bone resorption and decreased/unaltered bone formation
Low bone turnover
Hyperglycemia Hyperglycemia
Increased propensity to falldue to acute hypoglycemia and comorbid complications (eg retinopathy, neuropathy, cerebrovascular disease)
Increased propensity to falldue to acute hypoglycemia and comorbid complications (eg retinopathy, neuropathy, cerebrovascular disease)
Low bone mass Accelerated bone loss with aging
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cellsObesity
Bone Formation is Affected by Matrix AGEs (2)
Mechanical parameter
Control groupAGEs-treated
groupp
Elastic modulus (GPa)
12.7 ± 3.23 12.6 ± 0.823 0.93
Hardness 0.568 ± 0.171 0.587 ± 0.268 0.89
Mechanical properties of newly formed bone
Yang X et al. Calcif Tissue Int. 2016
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cells
Patsch J.M, et al. J Bone Miner Res. 2013
Diabetes influence bone structure independently by bone density
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cellsObesity
Diabetes Mellitus type II and Bone
Reduced recruitment of OB (in animals)
Reduced appositional rate (in animals)
Decreased bone formation (in humans)
Decreased bone resorption
Decreased bone turnover OC OPG
Gennari L. et al; The Journal of Clinical Endocrinology & Metabolism 2012
Diabetes Mellitus type II and Bone Turnover
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cellsObesity
Cohen A et al. The Journal of Clinical Endocrinology & Metabolism 2013
Obesity is associated with lowerbone volume and formation
Cohen A et al. The Journal of Clinical Endocrinology & Metabolism 2013
Obesity is associated with poor bone quality
AGENDA
• Epidemiology and fracture risk
• How T2DM affects bone
• Conclusions
AGEs Bone quality Bone turnover and cellsObesity