Conceptos Categóricos

INCREMENTO DEL RIESGO DE FRACTURAS EN PACIENTES CON DIABETES

INCREMENTO DEL RIESGO DE FRACTURAS EN PACIENTES CON DIABETES

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Tanto en la diabetes tipo 1 como en la diabetes tipo 2 se observa aumento del riesgo de fractura pero sólo en el primer caso existe reducción de la densidad mineral ósea.
vestergaard9.jpg Autor:
Peter Vestergaard
Columnista Experto de SIIC

Institución:
The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital


Artículos publicados por Peter Vestergaard
Recepción del artículo
31 de Julio, 2006
Aprobación
2 de Agosto, 2006
Primera edición
17 de Noviembre, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Además de las conocidas complicaciones de la diabetes, como retinopatía, nefropatía, neuropatía y arterioesclerosis, la osteoporosis y el incremento del riesgo de fracturas también son complicaciones de la diabetes. La patogenia de la osteoporosis y las fracturas en pacientes con diabetes es compleja. Los factores que pueden contribuir a las caídas y fracturas en pacientes diabéticos comprenden la alteración de la visión por retinopatía, la alteración del equilibrio postural por neuropatía y aterosclerosis, así como los episodios de hipoglucemia. La reducción de la densidad mineral ósea se relaciona con varios factores. Uno de ellos es el aumento de la excreción de calcio por orina relacionado con la excreción forzada de calcio debido a la hiperglucemia y glucosuria. El metabolismo de la vitamina D y de la parathormona puede estar alterado por hipoparatiroidismo funcional y disminución del nivel de 24,25-dihidroxi-vitamina D. La alteración del metabolismo de la vitamina D y de la parathormona es particularmente prominente en pacientes con función renal reducida. La microangiopatía puede alterar la función endotelial. La macroangiopatía con aterosclerosis puede conducir a reducción del aporte sanguíneo a los huesos. En pacientes con neuropatía, la carga alterada para los huesos también puede contribuir a la pérdida de hueso. La glucación también puede estar implicada, con deterioro del entrecruzamiento del colágeno y reducción de la función de los osteoblastos debido a formación de productos finales de glucación avanzada relacionados con la edad junto con alteraciones de los niveles de insulina y de factor de crecimiento símil insulina tipo 1 (IGF-I). El incremento del peso corporal observado en muchos pacientes con diabetes tipo 2 puede aumentar la densidad mineral ósea y prevenir las fracturas. El tratamiento con insulina y con hipoglucemiantes orales puede reducir el riesgo de fractura debido a la normalización de los niveles de glucemia.

Palabras clave
fractura, diabetes, osteoporosis


Artículo completo

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Abstract
Besides the well-known complications of diabetes such as retinopathy, nephropathy, neuropathy and arteriosclerosis, osteoporosis and increased fracture risk is also a complication of diabetes. The pathogenesis of osteoporosis and fractures in patients with diabetes is complex. An increased risk of falls due to impaired vision with retinopathy, altered postural balance with neuropathy and arteriosclerosis, and episodes of hypoglycaemia may contribute to falls and fractures. Reduced bone mineral density is related to many factors. One is increased calcium excretion in the urine linked to forced excretion of calcium due to hyperglycaemia and glucosuria. Vitamin D and PTH metabolism may be disturbed with functional hypoparathyroidism and a decreased level of 24,25-dihydroxy vitamin D. The impaired vitamin D and PTH metabolism is particularly prominent in patients with reduced renal function. Microangiopathy may alter endothelial function. Macroangiopathy with arteriosclerosis may lead to a decreased blood supply to the bones. Altered load to the bones in patients with neuropathy may also contribute to bone loss. Glycation with impaired cross linking of collagen and decreased osteoblast function due to formation of age related glycation end products (AGE) may also be involved along with alterations in insulin and IGF-I levels. The increased body weight seen in many patients with type 2 diabetes may increase BMD and be preventive of fractures. Treatment with insulin and oral antidiabetic medication may lower fracture risk due to normalisation of blood glucose levels.

Key words
diabetes, osteoporosis, fracture


Full text
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Especialidades
Principal: Diabetología
Relacionadas: Bioquímica, Medicina Interna, Osteoporosis y Osteopatías Médicas



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Enviar correspondencia a:
Peter Vestergaard, The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, DK-8000, Tage Hansens gade 2, Aarhus C, Dinamarca
Patrocinio y reconocimiento:
A la bibliotecaria Edith Clausen por su asistencia técnica con las referencias.
Bibliografía del artículo
1. McNair P, Madsbad S, Christensen MS, Christiansen C, Faber OK, Binder C et al. Bone mineral loss in insulin-treated diabetes mellitus: studies on pathogenesis. Acta Endocrinol 1979; 90:463-72.
2. Vestergaard P, Rejnmark L, Mosekilde L. Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 2005; 48:1292-9.
3. Carnevale V, Romagnoli E, D'Erasmo E. Skeletal involvement in patients with diabetes mellitus. Diabetes Metab Res Rev 2004; 20:196-204.
4. Raskin P, Stevenson MRM, Barilla DE, Pak CYC. The hypercalciuria of diabetes mellitus: its amelioration with insulin. Clin Endocrinol 1978; 9:329-35.
5. Bouillon R. Diabetic bone disease. Calcif Tissue Int 1991; 49:155-60.
6. Storm TL, Sørensen OH, Lund Bj, Lund Bi, Christiansen JS, Andersen AR et al. Vitamin D metabolism in insulin-dependent diabetes mellitus. Metab Bone Dis & Rel Res 1983; 5:107-10.
7. Nisbeth U, Lindh E, Ljunghall S, Backman U, Fellstrom B. Increased fracture rate in diabetes mellitus and females after renal transplantation. Transplantation 1999; 67:1218-22.
8. Thrailkill KM, Lumpkin CK, Jr., Bunn RC, Kemp SF, Fowlkes JL. Is insulin an anabolic agent in bone? Dissecting the diabetic bone for clues. Am J Physiol Endocrinol Metab 2005; 289:E735-E745.
9. Dunger DB, Acerini CL. IGF-I and diabetes in adolescence. Diabetes Metab 1998; 24:101-7.
10. Rix M, Andreassen H, Eskildsen P. Impact of peripheral neuropathy on bone density in patients with type 1 diabetes. Diabetes Care 1999; 22:827-31.
11. Vogt MT, Cauley JA, Kuller LH, Nevitt MC. Bone mineral density and blood flow to the lower extremities: The study of osteoporotic fractures. J Bone Miner Res 1997; 12:283-9.
12. Sanada M, Taguchi A, Higashi Y, Tsuda M, Kodama I, Yoshizumi M et al. Forearm endothelial function and bone mineral loss in postmenopausal women. Atherosclerosis 2004; 176:387-92.
13. Yamagishi S, Nakamura K, Inoue H. Possible participation of advanced glycation end products in the pathogenesis of osteoporosis in diabetic patients. Medical Hypotheses 2005; 65:1013-5.
14. Wood RJ, Allen LH, Bronner F. Regulation of calcium metabolism in streptozotocin-induced diabetes. Am J Physiol 1984; 247:R120-R123.
15. Heath III H, Lambert PW, Service FJ, Arnaud SB. Calcium homeostasis in diabetes mellitus. J Clin Endocrinol Metab 1979; 49:462-6.
16. Witt MF, White NH, Santiago JV, Seino Y, Avioli LV. Use of oral calcium loading to characterize the hypercalciuria of young insulin-dependent diabetics. J Clin Endocrinol Metab 1983; 57:94-100.
17. Christiansen C, Christensen MS, McNair P, Nielsen B, Madsbad S. Vitamin D metabolites in diabetic patients: decreased serum concentration of 24,25-dihydroxyvitamin D. Scand J Clin Lab Invest 1982; 42:487-91.
18. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J et al. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab 2004; 89:1196-9.
19. McNair P, Christensen MS, Madsbad S, Christiansen C, Transbol I. Hypoparathyroidism in diabetes mellitus. Acta Endocrinol (Copenh) 1981; 96:81-6.
20. Reid IR, Evans MC, Cooper GJ, Ames RW, Stapleton J. Circulating insulin levels are related to bone density in normal postmenopausal women. Am J Physiol 1993; 265:E655-E659.
21. Vestergaard P, Hermann AP, Ørskov H, Mosekilde L. Effect of sex hormone replacement on the insulin-like growth factor system and bone mineral: A cross-sectional and longitudinal study in 595 perimenopausal women participating in the Danish Osteoporosis Prevention Study. J Clin Endocrinol Metab 1999; 84:2286-90.
22. Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB et al. Changes in bone mineral density of the proximal femur and spine with aging: differences between the postmenopausal and senile osteoporosis syndromes. J Clin Invest 1982; 70:716-23.
23. Vestergaard P, Krogh K, Rejnmark L, Mosekilde L. Fracture rates and risk factors for fractures in patients with spinal cord injury. Spinal Cord 1998; 36:790-6.
24. Muñoz Torres M, Jodar E, Escobar Jiménez F, López Ibarra PJ, Luna JD. Bone mineral density measured by dual X-ray absorptiometry in Spanish patients with insulin-dependent diabetes mellitus. Calcif Tissue Int 1996; 58:316-9.
25. Mathiassen B, Nielsen S, Johansen JS, Hartwell D, Ditzel J, Rodbro P et al. Long-term bone loss in insulin-dependent diabetic patients with microvascular complications. J Diabet Complications 1990; 4:145-9.
26. McNair P, Christensen MS, Christiansen C, Madsbad S, Transbol I. Is diabetic osteoporosis due to microangiopathy? Lancet 1981; 1:1271.
27. Clausen P, Feldt-Rasmussen B, Jacobsen P, Rossing K, Parving HH, Nielsen PK et al. Microalbuminuria as an early indicator of osteopenia in male insulin-dependent diabetic patients. Diabet Med 1997; 14:1038-43.
28. Saito M, Fujii K, Soshi S, Tanaka T. Reductions in degree of mineralization and enzymatic collagen cross-links and increases in glycation-induced pentosidine in the femoral neck cortex in cases of femoral neck fracture. Osteoporos Int 2006.
29. Hein G, Weiss C, Lehmann G, Niwa T, Stein G, Franke S. Advanced glycation end product modification of bone proteins and bone remodelling: hypothesis and preliminary immunohistochemical findings. Ann Rheum Dis 2006; 65:101-4.
30. Viguet-Carrin S, Garnero P, Delmas PD. The role of collagen in bone strength. Osteoporos Int 2006; 17:319-36.
31. Odetti P, Rossi S, Monacelli F, Poggi A, Cirnigliaro M, Federici M et al. Advanced glycation end products and bone loss during aging. Ann N Y Acad Sci 2005; 1043:710-7.
32. Hein G, Wiegand R, Lehmann G, Stein G, Franke S. Advanced glycation end-products pentosidine and N epsilon-carboxymethyllysine are elevated in serum of patients with osteoporosis. Rheumatology (Oxford) 2003; 42:1242-6.
33. Miyata T, Notoya K, Yoshida K, Horie K, Maeda K, Kurokawa K et al. Advanced glycation end products enhance osteoclast-induced bone resorption in cultured mouse unfractionated bone cells and in rats implanted subcutaneously with devitalized bone particles. J Am Soc Nephrol 1997; 8:260-70.
34. Miyata T, Kawai R, Taketomi S, Sprague SM. Possible involvement of advanced glycation end-products in bone resorption. Nephrol Dial Transplant 1996; 11 Suppl 5:54-7.
35. Gundberg CM, Anderson M, Dickson I, Gallop PM. "Glycated" osteocalcin in human and bovine bone. The effect of age. J Biol Chem 1986; 261:14557-61.
36. De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P et al. Body mass index as a predictor of fracture risk: A meta-analysis. Osteoporosis Int 2005; 16:1330-8.
37. Greendale GA, Edelstein S, Barrett-Connor E. Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study. J Bone Miner Res 1997; 12:1833-43.
38. Van Beresteijn ECH, Van Laarhoven JPRM, Smals AGH. Body weight and/or endogenous estradiol as determinants of cortical bone mass and bone loss in healthy early postmenopausal women. Acta Endocrinol 1992; 127:226-30.
39. Forst T, Pfutzner A, Kann P, Schehler B, Lobmann R, Schafer H et al. Peripheral osteopenia in adult patients with insulin-dependent diabetes mellitus. Diabet Med 1995; 12:874-9.
40. Kayath MJ, Dib SA, Vieiaa JG. Prevalence and magnitude of osteopenia associated with insulin-dependent diabetes mellitus. J Diabetes Complications 1994; 8:97-104.
41. Moyer-Mileur LJ, Dixon SB, Quick JL, Askew EW, Murray MA. Bone mineral acquisition in adolescents with type 1 diabetes. J Pediatr 2004; 145:662-9.
42. Ponder SW, McCormick DP, Fawcett HD, Tran AD, Ogelsby GW, Brouhard BH et al. Bone mineral density of the lumbar vertebrae in children and adolescents with insulin-dependent diabetes mellitus. J Pediatr 1992; 120:541-5.
43. Tuominen JT, Impivaara O, Puukka P, Ronnemaa T. Bone mineral density in patients with type 1 and type 2 diabetes. Diabetes Care 1999; 22:1196-200.
44. De Liefde II, Van der KM, De Laet CE, Van Daele PL, Hofman A, Pols HA. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporosis Int 2005; 16 :1713-20.
45. Dennison EM, Syddall HE, Aihie SA, Craighead S, Phillips DI, Cooper C. Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance? Diabetologia 2004; 47:1963-8.
46. Maugeri D, Panebianco P, Destro G, Tropea S, Rizzo A, Carnazzo G et al. Senile diabetes and bone mineral density. Arch Gerontol Geriatr 1995; 20:241-8.
47. Pérez Castrillón JL, De Luis D, Martín Escudero JC, Asensio T, Del Amo R, Izaola O. Non-insulin-dependent diabetes, bone mineral density, and cardiovascular risk factors. J Diabetes Complications 2004; 18:317-21.
48. Schwartz AV, Sellmeyer DE, Strotmeyer ES, Tylavsky FA, Feingold KR, Resnick HE et al. Diabetes and bone loss at the hip in older black and white adults. J Bone Miner Res 2005; 20:596-603.
49. Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Zmuda JM et al. Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the health, aging, and body composition study. J Bone Miner Res 2004; 19:1084-91.
50. Van Daele PL, Stolk RP, Burger H, Algra D, Grobbee DE, Hofman A et al. Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam Study. Ann Intern Med 1995; 122:409-14.
51. Wakasugi M, Wakao R, Tawata M, Gan N, Koizumi K, Onaya T. Bone mineral density measured by dual energy x-ray absorptiometry in patients with non-insulin-dependent diabetes mellitus. Bone 1993; 14:29-33.
52. Weinstock RS, Goland RS, Shane E, Clemens TL, Lindsay R, Bilezikian JP. Bone mineral density in women with type II diabetes mellitus. J Bone Mineral Res 1989; 4:97-101.
53. Forsen L, Meyer HE, Midthjell K, Edna TH. Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 1999; 42:920-5.
54. Nicodemus KK,.Folsom AR. Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 2001; 24:1192-7.
55. Nabarro JD. Compression fractures of the dorsal spine in hypoglycaemic fits in diabetes. Br Med J (Clin Res Ed) 1985; 291:1320.
56. Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001; 86:32-8.
57. Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Bauer DC et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. Arch Intern Med 2005; 165:1612-7.
58. Cortés Sancho R, Pérez Castrillón JL, Martín Escudero JC, Iglesias S, Alvarez Manzanares P, Ramos R. Type 2 diabetes mellitus as a risk factor for hip fracture. J Am Geriatr Soc 2004; 52:1778-9.
59. Ahmed LA, Joakimsen RM, Berntsen GK, Fonnebo V, Schirmer H. Diabetes mellitus and the risk of non-vertebral fractures: the Tromso study. Osteoporos Int 2005; 1-6.
60. Hanley DA, Brown JP, Tenenhouse A, Olszynski WP, Ioannidis G, Berger C et al. Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study. J Bone Miner Res 2003; 18:784-90.
61. Maurer MS, Burcham J, Cheng H. Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J Gerontol A Biol Sci Med Sci 2005; 60:1157-62.
62. Ivers RQ, Mitchell P, Cumming RG, Peduto AJ. Diabetes and risk of fractures - the Blue Mountains Eye Study. Diabetes Care 2001; 24:1198-203.

 
 
 
 
 
 
 
 
 
 
 
 
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