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Clin Calcium. 2019;29(1):51-56. doi: CliCa19015156.

[Bone fragility in type 1 diabetes and type 2 diabetes.]

[Article in Japanese]

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Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine, Tokyo, Japan.


Diabetes mellitus causes hyperglycemia due to resistance to insulin action in peripheral organs in addition to progressive loss of β-cell function, thus it is involved in the development and progression of diabetic microangiopathy(retinopathy, nephropathy, and neuropathy). In addition, abnormalities of bone metabolism is regarded as a chronic complication related to both type 1 diabetes and type 2 diabetes. Accumulating evidence suggests that type 1 diabetes patients had decreased bone mineral density(BMD)and the fracture risk in the femoral neck is markedly higher, when compared to non-diabetic patients. A lack of insulin level in the portal vein is associated with systemic deficiencies of Insulin-like growth factor-1(IGF-1), known as growth-promoting polypeptide essential for promoting growth and bone formation. Thus, loss of IGF-1 play a crucial role for the pathogenesis of reduced BMD in type 1 diabetes. In type 2 diabetes, despite high bone mineral density with obesity, several studies have shown that men and women with type 2 diabetes mellitus are at increased risk for bone fracture. In other words, unlike type 1 diabetes patients, an increase in the risk of fracture in type 2 diabetes is significantly related to compromised bone quality, the other factor of impaired bone strength.


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