Skip to main content

Table 1 Summary of the mechanisms by which T2DM negatively affects the bone

From: The impact of type 2 diabetes on bone metabolism

  Mechanisms Effects on bone
AGEs Osteoclastogenesis and osteoblast dysfunction [28] Low bone quality [29, 30]
Increased risk of fragility fracture [28]
Insulin and IGF-1 Increases osteoblast proliferation and promotes collagen synthesis [38] Negative correlation with hip and vertebral fracture [39]
PPARγ Differentiate MSC into adipocytes [42] Suppression of osteoblastogenesis [43]
Enteric hormones (incretins) Energy intake releases GIP and GLP-2 [47,48,49,50] Low incretin levels decrease bone formation and augment resorption [47,48,49,50]
Osteocalcin Low levels in T2DM [54] Low levels decrease bone formation [57, 58]
Wnt/B-catenin pathway: sclerostin High levels in T2DM [59] High sclerostin levels increase bone resorption [59]
Vitamin D3 Low levels in T2DM [31]
Reduction of 1,25(OH)2D3 receptors [61]
Reduction of osteocalcin synthesis [61]
  1. The indirect and direct effects of compromised glucose/insulin metabolism on bone induces a decreased bone turnover, a reduced bone quality and an augmented risk of fractures
  2. AGEs advanced glycation end-products, IGF-1 insulin-like growth factor-1, PPARγ peroxisome proliferator-activated receptor gamma, MSC mesenchymal stem-cells, GIP glucose-dependent insulinotropic polypeptide, GLP-2 glucagon-like peptide-2, T2DM type 2 diabetes mellitus, 1,25(OH) 2 D3 1,25 dihydroxy vitamin D