Biochemical Markers of Bone Fragility in Patients with Diabetes. A Narrative Review by the IOF and the ECTS

Christian Meier; Richard Eastell; Dominique D Pierroz; Nancy E Lane; Nasser Al-Daghri; Atsushi Suzuki; Nicola Napoli; Ambrish Mithal; Marlene Chakhtoura; Ghada El-Hajj Fuleihan; Serge Ferrari

doi:10.1210/clinem/dgad255

Biochemical Markers of Bone Fragility in Patients with Diabetes. A Narrative Review by the IOF and the ECTS

J Clin Endocrinol Metab. 2023 May 8;108(10):e923-e936. doi: 10.1210/clinem/dgad255. Online ahead of print.

Authors

Affiliations

¹ Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Switzerland.
² Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
³ International Osteoporosis Foundation (IOF), Nyon, Switzerland.
⁴ Department of Medicine and Rheumatology, Davis School of Medicine, University of California, Sacramento, CA, USA.
⁵ Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.
⁶ Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
⁷ Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
⁸ Institute of Diabetes and Endocrinology, Max Healthcare, Saket, New Delhi, India.
⁹ Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon.
¹⁰ Service and Laboratory of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.

Abstract

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. This review summarizes current data on biochemical markers in relation to bone fragility and fracture risk in diabetes.

Methods: Literature review by a group of experts from the International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) 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 in diabetics similarly to non-diabetics, with similar reductions in fracture risk. Several other biochemical markers related to bone and glucose metabolism have been correlated with BMD and/or fracture risk in diabetes, including osteocyte-related markers such as sclerostin, HbA1c and advanced glycation end products (AGEs), inflammatory markers and adipokines, as well as IGF-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 HbA1c levels seem to provide a reliable estimate of fracture risk, while bone turnover markers could be used to monitor the effects of anti-osteoporosis therapy.

Keywords: adipokine; advanced glycation endproduct; bone turnover marker; diabetes; sclerostin.