Diabetes pharmacotherapy and effects on the musculoskeletal system

AbstractPersons with type 1 or type 2 diabetes (T1D, T2D) have a significantly higher fracture risk than age ‐matched persons without diabetes, attributed to disease‐specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin‐based therapies have shown divergent eff ects of different agents on fracture risk, including detrimental, beneficial and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall‐related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo‐anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in T2D, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium‐ dependent glucose co‐transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bon e quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes‐related muscle atrophy is more limited, although precl...
Source: Diabetes/Metabolism Research and Reviews - Category: Endocrinology Authors: Tags: REVIEW ARTICLE Source Type: research