Diabetes-induced osteoporosis. Review

The literature review highlights the impact of osteoporosis on the health of the population. The attention is focused on one of the secondary osteoporosis types, diabetes‑induced osteoporosis (DIO). The mechanisms of bone mass loss are highlighted, description is given to the interaction between osteoblasts and osteoclasts, the role of immune cells in the process of osteoporosis under conditions of hyperglycemia. The risk factors of DIO in type 1 and type 2 diabetes mellitus (DM) and the causes of bone mineral density reduction are described. Special attention is focused on the phenomenon of immunoporosis, which can lead to the creation and further development of new approaches to the targeted treatment of osteoporosis. High incidence of fractures in patients with type 1 diabetes (DM1) is caused by both negative hyperglycemia effects on the bone architectonics, and effects of hypoglycemia that raises the risk of falls. Along with hyperglycemic‑mediated processes in bone, the state of the microcirculatory bed, muscle tissue, and peripheral nervous system is important in DIO pathogenesis. In‑depth study of immunoporosis will contribute to the creation of new and development of existing approaches to the targeted osteoporosis treatment. Literature data show that incidence of any fractures’ is increased in three times in DM1 patients. The correlation between hyperglycemia, insulin, insulin‑like growth factor, anabolic hormones and C‑peptide with the development of diabetes‑induced osteoporosis has been revealed. Despite the lower date of fractures in DM2, comparing to the DM1, the main reasons for fractures include the high risk of falls, accumulation of advanced glycosylation end‑products, the low level of bone tissue metabolism, as well as obesity and insulin resistance. The effects of hypoglycemic drugs on fracture risk and bone mineral density have been characterized. Metformin and glucagon‑like peptide‑1 receptor agonists have the most favorable fracture safety profile. It has been suggested that bisphosphonates, androgens, and receptor activator of nuclear factor‑kappa B ligand (RANKL) inhibitor may be the most effective drugs against osteoporosis in patients with DM.