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Diabetic Bone Disease

Diabetic (charcot) Foot

Diabetic (charcot) Foot

Diabetes is a condition of elevated blood sugar that affects about 6 percent of the population in the United States, or about 16 million people. Diabetic foot problems are a major health concern and are a common cause of hospitalization. Most foot problems that people with diabetes face arise from two serious complications of the disease: nerve damage and poor circulation. One of the more critical foot problems these complications can cause is Charcot arthropathy, which can deform the shape of the foot and lead to disability. There are treatment options for the wide range of diabetic foot problems. The most effective treatment, however, is prevention. For people with diabetes, careful, daily inspection of the feet is essential to overall health and the prevention of damaging foot problems. Description Nerve damage (neuropathy) is a complication of diabetes that leads to a loss of sensation in the feet. Some people with diabetes can no longer feel when something has irritated or even punctured the skin. A wound as small as a blister can progress to a serious infection in a matter of days. Diabetes also damages blood vessels, decreasing the blood flow to the feet. Poor circulation weakens bone, and can cause disintegration of the bones and joints in the foot and ankle. As a result, people with diabetes are at a high risk for breaking bones in the feet. When a diabetic fractures a bone in the foot, he or she may not realize it because of nerve damage. Continuing to walk on the injured foot results in more severe fractures and joint dislocations. Sharp edges of broken bone within the foot can point downward toward the ground, increasing the risk of chronic foot sores from the abnormal pressure. (Left) This patient with Charcot of the ankle has developed a deformity that pla Continue reading >>

Assessment Of Bone Turnover And Bone Quality In Type 2 Diabetic Bone Disease: Current Concepts And Future Directions

Assessment Of Bone Turnover And Bone Quality In Type 2 Diabetic Bone Disease: Current Concepts And Future Directions

Review Article | Open Assessment of bone turnover and bone quality in type 2 diabetic bone disease: current concepts and future directions Bone Research volume 4, Articlenumber:16001 (2016) Substantial evidence exists that in addition to the well-known complications of diabetes, increased fracture risk is an important morbidity. This risk is probably due to altered bone properties in diabetes. Circulating biochemical markers of bone turnover have been found to be decreased in type 2 diabetes (T2D) and may be predictive of fractures independently of bone mineral density (BMD). Serum sclerostin levels have been found to be increased in T2D and appear to be predictive of fracture risk independent of BMD. Bone imaging technologies, including trabecular bone score (TBS) and quantitative CT testing have revealed differences in diabetic bone as compared to non-diabetic individuals. Specifically, high resolution peripheral quantitative CT (HRpQCT) imaging has demonstrated increased cortical porosity in diabetic postmenopausal women. Other factors such as bone marrow fat saturation and advanced glycation endproduct (AGE) accumulation might also relate to bone cell function and fracture risk in diabetes. These data have increased our understanding of how T2D adversely impacts both bone metabolism and fracture risk. Type 2 diabetes mellitus (T2D) is an exceedingly common chronic metabolic disorder that has an enormous impact on public health. Currently, diabetes affects over 387 million adults worldwide and is projected to reach 592 million by 2035. 1 Until recently, the list of target organs affected by T2D did not include the skeleton. Yet it is now well-established that T2D is an independent risk factor for fractures, which is not attributable to increased body mass index (BMI Continue reading >>

Kidneys And Bone Disease

Kidneys And Bone Disease

The kidneys play a very important role in the health of your bones. The kidneys work with the parathyroid glands, (named for their proximity to the thyroid gland, but their function is very different than thyroid gland) to regulate calcium and phosphorus. Normally, we obtain vitamin D from sunlight or our diet. Vitamin D helps us absorb calcium from our diets but it must be activated first in the liver and then in the kidneys. Dietary vitamin D deficiency is very common in the general population. Also, if the kidneys are not working properly, then the kidneys cannot activate vitamin D and the calcium cannot be fully absorbed. In this situation, blood calcium levels can fall. When the calcium levels fall, the parathyroid glands become active to leach calcium from bones and into the circulation and return calcium levels to normal. A second factor can affect the activity of the parathyroid glands. If the kidneys are not working properly, then they cannot get rid of all the phosphate in our diet. Then the phosphate levels can rise. This also activates the parathyroid glands. High phosphorous also accelerates the decline in kidney function. Parathyroid hormone can instruct the kidney to work harder at excreting phosphate. Yet when this occurs, the parathyroid hormone still works on the bones to liberate calcium. When this hormone damages the bones to keep the blood levels of calcium and phosphorus normal, this is called renal osteodystrophy or renal bone disease. Click here forinformation onthe Renal (Kidney Health) Clinic at Joslin Diabetes Center Continue reading >>

Sweet Bones: The Pathogenesis Of Bone Alteration In Diabetes

Sweet Bones: The Pathogenesis Of Bone Alteration In Diabetes

Sweet Bones: The Pathogenesis of Bone Alteration in Diabetes Department of Physiology, College of Medicine, University of Dammam, P. O. Box 2114-31451, Dammam, Saudi Arabia Received 17 July 2016; Accepted 15 September 2016 Copyright 2016 Mohammed Al-Hariri. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetic patients have increased fracture risk. The pathogenesis underlying the status of bone alterations in diabetes mellitus is not completely understood but is multifactorial. The major deficits appear to be related to a deficit in mineralized surface area, a decrement in the rate of mineral apposition, deceased osteoid surface, depressed osteoblast activity, and decreased numbers of osteoclasts due to abnormal insulin signaling pathway. Other prominent features of diabetes mellitus are an increased urinary excretion of calcium and magnesium, accumulation of advanced glycation end products, and oxidative stress leading to sweet bones (altered bones strength, metabolism, and structure). Every diabetic patient should be assessed for risk factors for fractures and osteoporosis. The pathogenesis of the bone alterations in diabetes mellitus as well as their molecular mechanisms needs further study. Diabetes mellitus is a common chronic hyperglycemic, prevalent disease, with significant associated mortality and morbidity that affects millions of population worldwide. It is associated with a variety of complications that are well known to healthcare providers. In time, the bones may also be affected, in addition to many other organs. However, the status of bones as well as their disorders in patients with d Continue reading >>

Bone And Joint Problems Associated With Diabetes

Bone And Joint Problems Associated With Diabetes

If you have diabetes, you're at increased risk of various bone and joint disorders. Certain factors, such as nerve damage (diabetic neuropathy), arterial disease and obesity, may contribute to these problems — but often the cause isn't clear. Learn more about various bone and joint disorders, including symptoms and treatment options. Charcot joint What is it? Charcot (shahr-KOH) joint, also called neuropathic arthropathy, occurs when a joint deteriorates because of nerve damage — a common complication of diabetes. Charcot joint primarily affects the feet. What are the symptoms? You might have numbness and tingling or loss of sensation in the affected joints. They may become warm, red and swollen and become unstable or deformed. The involved joint may not be very painful despite its appearance. How is it treated? If detected early, progression of the disease can be slowed. Limiting weight-bearing activities and use of orthotic supports to the affected joint and surrounding structures can help. Diabetic hand syndrome What is it? Diabetic hand syndrome, also called diabetic cheiroarthropathy, is a disorder in which the skin on the hands becomes waxy and thickened. Eventually finger movement is limited. What causes diabetic hand syndrome isn't known. It's most common in people who've had diabetes for a long time. What are the symptoms? You may be unable to fully extend your fingers or press your palms together flat. How is it treated? Better management of blood glucose levels and physical therapy can slow the progress of this condition, but the limited mobility may not be reversible. Osteoporosis What is it? Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who have type 1 diabetes have an increased risk of osteoporosis. What are Continue reading >>

Bone Disease, Gestational Diabetes Mellitus, And Health Care

Bone Disease, Gestational Diabetes Mellitus, And Health Care

This is the seventh of a series of articles based on presentations at the American Diabetes Association (ADA) Scientific Sessions held 6–10 June 2008 in San Francisco, California. Type 2 diabetes and bone disease Robert Josse (Toronto, Canada) discussed new concepts of skeletal homeostasis and its disorders in a symposium addressing the relationship of type 2 diabetes, and in particular that of thiazolidinedione (TZD) treatment, to bone disease. Remodeling is the process of combined osteoclast and osteoblast activity that optimizes bone structure to improve strength and mechanical function and repair microdamage, fulfills metabolic functions, and acts as an important source of growth factors. The basic multicellular units of bone contain osteoclasts that excavate bone, mononuclear cells that remove cellular debris, and osteoblasts that replace the removed bone. Receptor activator of nuclear factor-κB (RANK) ligand is a transmembrane protein belonging to the tumor necrosis factor superfamily that specifically binds RANK and osteoprotegerin and plays an important role in regulating osteoclast differentiation and activation, whereas the Wnt (related to a gene controlling wing forming in fruit flies) system controls osteoblast activity with complex signals linking osteoblasts and osteoclasts (1). An LDL receptor–related protein (LRP)5 mutation is associated with increased bone mass. The LRP5/Wnt signaling pathway increases activity of the multifunctional protein β-catenin that participates in cell adhesion and nuclear signaling and is inhibited by an osteocyte product sclerostin (defects in this are associated with sclerositis) and by the antagonist Dickkopf (DKK) proteins. DKK1 is a myeloblast product that helps explain the failure of multiple myeloma lesions to show Continue reading >>

Diabetic Bone Disease

Diabetic Bone Disease

Basic and Translational Research and Clinical Applications Editors: Lecka-Czernik, Beata, Fowlkes, John L. (Eds.) A comprehensivepresentation of the current research and treatment for skeletal deficits and complications due to diabetes type 1 and 2 Covers epidemiology, fracture risk assessment, biomarkers, biomechanics, bone quality, and the safety and efficacy of anti-diabeteic therapy on bone health An excellent resource for endocrinologists and orthopedists alike ebooks can be used on all reading devices Usually dispatched within 3 to 5 business days. Usually dispatched within 3 to 5 business days. Providing the most up-to-date research and current clinical knowledge of diabetic bone disease and the challenges still facing the research and clinical care communities, this book unites insights from endocrinology and orthopedics to create a truly unique text. The first part covers clinical and pre-clinical applications and research. The first two chapters present the clinical and epidemiological data about diabetic bone disease, evaluated and reviewed for type 1 and type 2, respectively. This is followed by discussions of how the propensity to fracture in diabetic bone disease can impact fracture risk assessments and how it can be adjusted for using current clinically relevant fracture risk models. A comprehensive overview of orthopedic complications observed in diabetes is next, as well as a focus on the consequences of diabetes on periodontal disease. Other topics include the utility of skeletal biomarkers in assessing diabetic bone disease, how drugs used to treat diabetes may also have skeletal consequences, and the possibility that diabetes may fundamentally impact early progenitor cells of various bone lineages and thus globally impact bone. The second part cover Continue reading >>

Bone Disease In Diabetes.

Bone Disease In Diabetes.

1. Curr Diabetes Rev. 2010 May;6(3):144-55. (1)Endocrinology Department, Complejo Hospitalario Universitario A Corua, As Xubias 84, 15006 A Corua, Spain. [email protected] The relationship between diabetes and bone disease is complex. While low bonemineral density (BMD) is consistently observed in type 1 diabetes (T1DM), in type2 diabetes (T2DM) bone mineral density is similar to or higher than in nondiabetic subjects. Yet, for both types of diabetes bone appears to be morefragile for a given density. Recent meta-analyses and cohort studies confirm thatT1DM and T2DM are associated with higher fracture risk. Many factors influencethe probability of fractures. Diabetes can affect bone through multiple pathways including obesity, changes in insulin levels, higher concentrations of advancedglycation end products in collagen, increased urinary excretion coupled withlower intestinal absorption of calcium, inappropriate homeostatic response ofparathyroid hormone secretion, complex alterations of vitamin D regulation,reduced renal function, lower insulin-like growth factor-I, microangiopathy, and inflammation. Data on cellular mechanisms and experimental models are extensive, but the relevance of each one of these factors to the clinical situation isunclear. In this article we review the pathophysiological mechanisms potentially involved in the altered BMD found in diabetic patients, show data on theincreased risk of fractures, and speculate on the potential causes of theincreased risk of fractures in this context. Finally, we comment on theprevention and treatment of osteoporosis in diabetes, although the lack of trialstesting the use of pharmacotherapy on preventing fractures in this context isemphasized. Continue reading >>

Joint Pain And Bone Conditions

Joint Pain And Bone Conditions

Tweet Diabetes affects both the nerves and circulation which can result in joint pain and disorders developing in a number of areas of the body. In terms of the complications of diabetes, joint disorders tend to get mentioned less than the likes of retinopathy and kidney disease but some of the conditions can be serious. Charcot foot Charcot foot, also known as Charcot arthropathy and Charcot joint, is the name for a condition which causes the foot to swell and, in progressed cases, deform. Symptoms of Charcot foot include: Swelling or redness of joints in the foot Affected foot being warmer than the non-affected foot Pain in the affected area will be noticed Charcot foot can affect any of the weight bearing joints in the foot including the ankle. Charcot joint can be treated but the treatment takes time, up to several months, typically involving casting the foot and taking weight off it. Read more about Charcot foot Osteoporosis Osteoporosis, meaning porous bones, is a condition which causes bones to weaken. Areas which tend to be affected are the spine, wrist and hips. Symptoms develop slowly and can be hard to notice until an event causes a bone to break or fracture, termed as a ‘fragility fracture’. Treatment may include extra vitamin D and/or calcium in your diet and exercises to build up strength in the bones are often prescribed. Osteoarthritis Osteoarthritis includes inflammation of the tissues in the joints and damage to cartilage. People who are overweight put extra strain on their joints and can increase the risk of osteoarthritis as well as making the condition more pronounced. Osteoarthritis symptoms Symptoms include: Pain Stiffness A grating sound or a limited range of mobility in the joints. Osteoarthritis becomes more likely in old age, with 50 years Continue reading >>

Just What Is The Link Between Diabetes Mellitus And Osteoporosis And Bone Fractures?

Just What Is The Link Between Diabetes Mellitus And Osteoporosis And Bone Fractures?

If you have diabetes, you probably already know that you have to worry about many potential problems with different body organs–your eyes, your kidneys, your heart. But there is another connection to worry about: your bones. Compared to individuals without diabetes, both men and women with diabetes have a higher risk of fractures, particularly at the hip, with its consequent significant impact on daily life. And if you are older and have diabetes, studies have demonstrated an elevated risk of not only hip fractures, but also those of the upper arm and foot. Women with type 1 diabetes ( the diabetes that results from the loss of insulin production from the pancreas) are approximately 12-fold more likely to have a fracture than women without diabetes, according to data from the Iowa Women’s Health Study. The reasons for why those who have diabetes mellitus have an increased risk for osteoporosis and bone fractures are not entirely clear at this time. This article will discuss some of the potential causes for this associated increased risk and will make some suggestions for prevention of osteoporosis and bone fractures. There have been several large studies that have shown that individuals with either type 1 diabetes or type 2 ( the diabetes that results from insulin not working as it should, compounded by progressive loss of the body’s ability to make insulin) have increased risk of bone fractures and osteoporosis. The link between fractures and diabetes seems to be stronger if you have type 1 diabetes than if you have type 2 diabetes. Type 1 diabetes is associated with decreased bone mass and although data for bone mass in type 2 diabetes may or may not be decreased, there is evidence of altered bone quality. The potential causes could be directly from glucose (blo Continue reading >>

Diabetes, Bones - Diabetes Self-management

Diabetes, Bones - Diabetes Self-management

Osteoporosis is the most common type of bone disorder, affecting an estimated 10 million Americans. It is a chronic condition characterized by reduced bone strength, low bone mass, and a higher risk of bone fracture, especially at the hip, spine, and wrist. If you are over the age of 50, there is a 55% chance that you are at increased risk for osteoporosis or have it already. The risk of osteoporosis increases with age; it is not, however, limited to older individuals. Osteoporosis can be prevented or slowed down, but once damage to the bone has taken place, it can be difficult to reverse. Bone fractures are the main consequence of osteoporosis, and they are associated with lasting disability after they occur, especially hip fractures in older people. For reasons that are still unclear, people with both Type 1 and Type 2 diabetes experience a higher incidence of bone fracture than the general population, even though people with Type 2 diabetes tend to have above-average bone density. It is especially important, then, for people with diabetes to know about osteoporosis, to have their risk of fracture evaluated by medical professionals, and to find out what they can do to make their bones as strong and healthy as possible. One way health-care providers evaluate a persons risk of osteoporosis is to do a bone mineral density (BMD) test. The most common test uses x-ray beams, is painless, and can be done in a matter of minutes. BMD is a core indicator of bone strength. A test for BMD measures the amount of a mineral, usually calcium, in a bone. This measurement is then compared to the pooled measurements of a group of healthy young adults using a statistical indicator called a standard deviation. If the BMD of the person being evaluated is 2.5 standard deviations or more be Continue reading >>

The Impact Of Sglt2 Inhibitors, Compared With Insulin, On Diabetic Bone Disease In A Mouse Model Of Type 1 Diabetes - Sciencedirect

The Impact Of Sglt2 Inhibitors, Compared With Insulin, On Diabetic Bone Disease In A Mouse Model Of Type 1 Diabetes - Sciencedirect

The impact of SGLT2 inhibitors, compared with insulin, on diabetic bone disease in a mouse model of type 1 diabetes Author links open overlay panel Kathryn M.ThrailkillMDab Deficits in appendicular and axial bone microarchitecture and strength are consistently observed in long-term hypoinsulinemic diabetes Normalization of glycemic control, via SGLT2I + insulin co-therapy, prevents diabetic bone disease in a mouse model of T1D Glycemic status is predictive of bone phenotype SGLT2-Inhibitor therapy alone may impart secondary effects on bone turnover. Monitoring the effects of SGLT2Is on skeletal outcomes remains relevant Skeletal co-morbidities in type 1 diabetes include an increased risk for fracture and delayed fracture healing, which are intertwined with disease duration and the presence of other diabetic complications. As such, chronic hyperglycemia is undoubtedly a major contributor to these outcomes, despite standard insulin-replacement therapy. Therefore, using the streptozotocin (STZ)-induced model of hypoinsulinemic hyperglycemia in DBA/2J male mice, we compared the effects of two glucose lowering therapies on the fracture resistance of bone and markers of bone turnover. Twelve week-old diabetic (DM) mice were treated for 9weeks with: 1) oral canagliflozin (CANA, dose range ~1016mg/kg/day), an inhibitor of the renal sodium-dependent glucose co-transporter type 2 (SGLT2); 2) subcutaneous insulin, via minipump (INS, 0.125units/day); 3) co-therapy (CANA+INS); or 4) no treatment (STZ, without therapy). These groups were also compared to non-diabetic control groups. Untreated diabetic mice experienced increased bone resorption and significant deficits in cortical and trabecular bone that contributed to structural weakness of the femur mid-shaft and the lumbar verteb Continue reading >>

Adynamic Bone Disease Prevalent In Type 2 Diabetes Patients With Ckd

Adynamic Bone Disease Prevalent In Type 2 Diabetes Patients With Ckd

Adynamic Bone Disease Prevalent in Type 2 Diabetes Patients With CKD Adynamic Bone Disease Prevalent in Type 2 Diabetes Patients With CKD Adynamic bone disease may be the most common manifestation of chronic kidney disease mineral bone disorder (CKD-MBD ) in pre-dialysis patients with type 2 diabetes, new research shows. Sayantan Ray, MBBS, MD, of the Institute of Post Graduate Medical Education & Research and SSKM Hospital in India, and colleagues investigated the profile of CKD-MBD in 72 patients with type 2 diabetes with newly-diagnosed stage 45 CKD not on dialysis (mean age 54.2; 39% female). None of the patients had received treatment with calcium supplements, phosphate binders, vitamin D analogues, glucocorticoids, anticonvulsants, non-steroidal anti-inflammatory drugs, or bisphosphonates. The investigators defined adynamic bone disease as intact pararthyroid hormone (iPTH) levels below 70 pg/mL in stage 4 CKD and below 100 pg/mL in stage 5 CKD. The study revealed hyperparathyroidism in 43% of patients with stage 4 CKD (iPTH above 110 pg/mL) and 32% of patients with stage 5 CKD (iPTH above 300 pg/mL), suggesting that high bone turnover disease was not predominant in this population. Nearly 40% of patients in each group (CKD stage 4 and 5) showed biochemical parameters consistent with low turnover bone disease, highlighting that adynamic bone disease is prevalent even in [the] pre-dialysis CKD population, Dr Ray and his team concluded in a paper published online ahead of print in Diabetes & Metabolic Syndrome: Clinical Research & Reviews. They also noted that the relatively low prevalence of hyperparathyroidism in their cohort could mean that high bone turnover disease may not be the most prevalent type in diabetic CKD. Laboratory results showed that roughly a thi Continue reading >>

Diabetes And Bone Fragility: An Underappreciated Complication

Diabetes And Bone Fragility: An Underappreciated Complication

Diabetes and Bones: An Underappreciated Complication Diabetes can be weakening the skeleton despite apparently good bone mineral density scores. Fortunately, standard osteoporosis treatments appear to be just as successful in patients with diabetes. The damage that diabetes can do to bones is a complication that many endocrinologists do not adequately appreciate, say researchers in the field. The danger is insidious because bone mineral density (BMD) scores cannot be taken at face value diabetes patients are at much higher risk for fracture compared with healthy patients with the same BMD scores. Guidelines for diabetes care recommend evaluating patients at least annually for long-term complications, such as heart, eye, kidney, and nerve disease, and skeletal complications should be added to that list, says Vikram V. Shanbhogue, MD, PhD, of the Endocrinology Department at Odense University Hospital in Denmark. He says that several European guidelines dont even mention bone as a complication, and the American Diabetes Association at least mentions bone fragility or osteoporosis as a comorbid condition in diabetes, but the potential complication deserves a higher profile. I think it is important to emphasize the point that skeletal deterioration is another diabetic complication. We understand that patients who have poorly controlled diabetes are going to have worse bone quality, and that will predispose them to an increased fracture risk. Mishaela R. Rubin, MD, associate professor of medicine, Columbia University Medical Center, New York The evaluation of a type 2 diabetes patients status is difficult because their BMD T-scores are hard to interpret it appears that the risk point is as much as a half to a full standard deviation higher in type 2 diabetes, Shanbhogue says Continue reading >>

Bone Disease And Diabetes Mellitus

Bone Disease And Diabetes Mellitus

Location: Eken, S2:02, Norrbacka, Karolinska University Hospital, Solna Department: Inst fr molekylr medicin och kirurgi / Dept of Molecular Medicine and Surgery Diabetes Mellitus (DM) and Osteoporosis (OP) frequently co-exist with advanced age and imply large health challenges worldwide. The last decades there has been a growing interest regarding fracture risk in DM. Currently used screening methods (Dual Energy X-ray Absorptiometry (DXA) and FRAX) underestimate fracture risk in diabetes patients. New methods for risk assessment are needed. In my thesis, we have studied the significance of neuropathy, the IGF-system and metabolic control in relation to bone mineral density and fracture risk in DM, both in a rat-model and in humans. Study I: In an epidemiological register study of 24 605 patients, 12 551 men and 12054 women with T1DM the cumulative incidence of hip fractures was analyzed. Conclusion: Both men and women with TIDM have a several folds increased risk for hip fracture with higher risk in those with peripheral neuropathy. Study II: Diabetic osteopathy and the IGF-system were analyzed in an animal model of mild T2DM, the Goto-Kakizaki rat, to assess the systemic as well as local bone and joint status. Conclusion: Bone mineral density (BMD) was lower in peripheral bone in diabetic compared to control rats and there were both systemic and local disturbances of the IGF-system. Study III: Bone and joint neuropathy were studied in the same diabetic rats and compared to controls to explore and define abnormalities of the peripheral nervous system in diabetic osteopathy according to nerve conduction velocity and neuropeptide expression in bone and joints. Conclusion: Rats with mild T2DM and neuropathy exhibited neuropeptidergic changes in the periphery, especially Continue reading >>

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