Abstract
Osteoporosis and diabetes mellitus represent global health problems due to their high, and increasing with aging, prevalence in the general population. Osteoporosis can be successfully treated with both antiresorptive and anabolic drugs. While these drugs are clearly effective in reducing the risk of fracture in patients with postmenopausal and male osteoporosis, it is still unclear whether they may have the same efficacy in patients with diabetic osteopathy. Furthermore, as bone-derived cytokines (osteokines) are able to influence glucose metabolism, it is conceivable that antiosteoporotic drugs may have an effect on glycemic control through their modulation of bone turnover that affects the osteokines’ release. These aspects are addressed in this narrative review by means of an unrestricted computerized literature search in the PubMed database. Our findings indicate a balance between good and bad news. Active bone therapies and their modulation of bone turnover do not appear to play a clinically significant role in glucose metabolism in humans. Moreover, there are insufficient data to clarify whether there are any differences in the efficacy of antiosteoporotic drugs on fracture incidence between diabetic and nondiabetic patients with osteoporosis. Although more studies are required for stronger recommendations to be issued, bisphosphonates appear to be the first-line drug for treatment of osteoporosis in diabetic patients, while denosumab seems preferable for older patients, particularly for those with impaired renal function, and osteoanabolic agents should be reserved for patients with more severe forms of osteoporosis.
Highlights
Osteoporosis and diabetes mellitus (DM) represent global health problems due to their high prevalence in the general population, and significant effort has been made in order to effectively manage these diseases
The osteokines produced during the bone remodeling process may influence glucose metabolism
receptor activator of nuclear factor kappa-B ligand (RANKL) seems to worsen insulin sensitivity, while the decoy receptor OPG, which physiologically antagonizes the activity of RANKL on osteoclast precursors, is able to delay the onset of hyperglycemia in diabetic animals
Summary
As bone-derived cytokines (osteokines) are able to influence glucose metabolism, it is conceivable that antiosteoporotic drugs may have an effect on glycemic control through their modulation of bone turnover that affects the osteokines’ release. More studies are required for stronger recommendations to be issued, bisphosphonates appear to be the first-line drug for treatment of osteoporosis in diabetic patients, while denosumab seems preferable for older patients, for those with impaired renal function, and osteoanabolic agents should be reserved for patients with more severe forms of osteoporosis This quote by Leonardo da Vinci means “wisdom is the daughter of experience,” and nothing is truer when approaching the complex interplay between bone and glucose metabolism.
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