02-26-2018 | Osteoporosis | Figure | Image
Impairments in glucose and insulin metabolism have indirect and direct effects on bone quality in individuals with diabetes. Impaired glucose/insulin metabolism may indirectly affect bone by altering skeletal muscle signalling. Furthermore, in metabolic disease, the accumulation of advanced glycation end-products may trigger pathways that promote collagen cross-linking (altering bone biomechanics) and impact on bone remodelling. Furthermore, the bone vasculature is disturbed with dysregulation in glucose and insulin metabolism, so that the delivery of nutrients and signalling factors (eg, that regulate vasodilation) to the bone is impaired. The changes in bone vasculature in diabetes results in decreased remodelling activity in the bone. Impairments in glucose and insulin metabolism also directly impact on osteoblast and osteoclast activity, resulting in decreased bone formation and bone resorption. Ultimately, the indirect and direct effects of impaired glucose/insulin metabolism on bone lead to decreased bone remodelling/turnover, decreased bone quality and increased risk of fractures.