Biochemical Markers of Bone Fragility in Patients With Diabetes

Context The risk of fragility fractures is increased in both type 1 and type 2 diabetes. Numerous biochemical markers reflecting bone and/or glucose metabolism have been evaluated in this context. Objective This review summarizes current data on biochemical markers in relation to bone fragility and fracture risk in diabetes. Methods A group of experts from the International Osteoporosis Foundation and European Calcified Tissue Society reviewed the literature focusing on biochemical markers, diabetes, diabetes treatments, and bone in adults. Results Although bone resorption and bone formation markers are low and poorly predictive of fracture risk in diabetes, osteoporosis drugs seem to change bone turnover markers (BTMs) in diabetics similarly to nondiabetics, with similar reductions in fracture risk. Several other biochemical markers related to bone and glucose metabolism have been correlated with bone mineral density and/or fracture risk in diabetes, including osteocyte-related markers such as sclerostin, glycated hemoglobin A(1c) (HbA(1c)) and advanced glycation end products, inflammatory markers, and adipokines, as well as insulin-like growth factor-1 and calciotropic hormones. Conclusion Several biochemical markers and hormonal levels related to bone and/or glucose metabolism have been associated with skeletal parameters in diabetes. Currently, only HbA(1c) levels seem to provide a reliable estimate of fracture risk, while BTMs could be used to monitor the effects of antiosteoporosis therapy.

Automated summary

This review provides a summary of current data on biochemical markers in relation to bone fragility and fracture risk in diabetes. The results show that although bone resorption and bone formation markers are not effective predictors of fracture risk in diabetes, osteoporosis drugs have similar effects on bone turnover markers in both diabetics and nondiabetics, resulting in reduced fracture risk. Other biochemical markers related to bone and glucose metabolism, such as sclerostin, glycated hemoglobin A(1c), and inflammatory markers, as well as hormones like insulin-like growth factor-1 and calciotropic hormones, are also associated with bone mineral density and fracture risk in diabetes. HbA(1c) levels appear to be the most reliable estimate of fracture risk, while bone turnover markers can be used to monitor the effects of antiosteoporosis therapy.