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Type 2 Diabetes And Bone Healing

The Impact Of Type 2 Diabetes On Bone Fracture Healing

The Impact Of Type 2 Diabetes On Bone Fracture Healing

Home The impact of type 2 diabetes on bone fracture healing The impact of type 2 diabetes on bone fracture healing Marin, Carlos Luyten, Frank Van Der Schueren, Bart Kerckhofs, Greet [UCL] Vandamme, Katleen Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing. "Frontiers in Endocrinology" - Vol. 9, no. 6 (2018) [Handle] Andrikopoulos Sofianos, Blair Amy R., Deluca Nadia, Fam Barbara C., Proietto Joseph, Evaluating the glucose tolerance test in mice, 10.1152/ajpendo.90617.2008 Lecka-Czernik B., Stechschulte L.A., Czernik P.J., Dowling A.R., High bone mass in adult mice with diet-induced obesity results from a combination of initial increase in bone mass followed by attenuation in Continue reading >>

Research

Research

Fracture healing is a process of restoring the structural and biological properties of injured bone. It has been well documented that diabetes mellitus (DM), a systemic disease affecting 17 million Americans, causes increased healing time with a concomitant increase in delayed unions and nonunions. Unfortunately, the specific mechanism for the delayed fracture healing in patients with diabetes has yet to be elucidated. The purpose of our research is to evaluate the role of insulin and glucose control on the fracture healing process using our recently established femur fracture model in diabetic BB Wistar rats. We theorize that insulin plays a critical role in the fracture callus, especially on the early inflammatory phase and the expression of local growth factors, and its relative absence leads to impaired fracture healing in diabetics. Annually, 6 million fractures are treated in the U.S., with 5-10% exhibiting complications such as delayed union or non-union. Etiologies of impaired fracture healing include smoking, open fractures, presence of underlying infection, certain medications (i.e. steroids) as well as systemic disease such as diabetes mellitus (DM). It is estimated that more than 30 million Americans will be diagnosed with diabetes within the next decade. The effects of diabetes upon fracture healing have been well documented with increased healing time (2-3 times the normal rate) and concomitant increased complications (delayed union, non-union, etc). In order to study these problems, our lab has established a diabetic femur fracture model for analyzing the effect of tight blood glucose and the role of early critical growth factors upon impaired diabetic fracture healing. Diabetic Femur Fracture Model Previous diabetic models were induced with cytotoxic age Continue reading >>

Bone Fractures: A Diabetes Complication Often Ignored

Bone Fractures: A Diabetes Complication Often Ignored

Bone Fractures: A Diabetes Complication Often Ignored Many people aren't aware of the connection between diabetes and bone fractures. Find out how you can protect your bones and guard against this complication of diabetes. Videos: Eating Smart With Martha McKittrick, RD If you have diabetes, youve likely been told to be vigilant about blood sugar control. Thats because when unmanaged, diabetes can increase your risk of complications such as heart disease, nerve damage, and kidney failure, according to the American Diabetes Association. But there's a lesser-known yet still serious diabetes complication that youll also need to watch out for: bone fractures. Health care providers often neglect to tell patients with diabetes that they could be at higher risk of bone fractures, says M. James Lenhard, MD, section chief of endocrinology and medical director of the Diabetes and Metabolic Diseases Center, the Diabetes and Metabolic Research Center, and the Weight Management Center at the Christiana Care Health System in Wilmington, Delaware. However, it's a real risk that can affect people with either type 1 or type 2 diabetes. In fact, people with type 2 diabetes could have three times greater the risk of bone fracture than those with normal blood sugar, depending on skeleton size and how long someone has had diabetes, according to research published in December 2014 in Metabolism. Type 1 diabetes also increases the risk of bone fractures, according to an animal study. Researchers from the University of Delaware in Newark, where Dr. Lenhard is an adjunct associate professor, and the University of Toronto, found that exercise (normally a good protective step for bone health) did not stimulate bone regeneration as well in mice with high blood sugar levels as it did in mice with Continue reading >>

Diabetes And Its Effect On Bone And Fracture Healing

Diabetes And Its Effect On Bone And Fracture Healing

Diabetes and Its Effect on Bone and Fracture Healing Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China Hongli Jiao, Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; The publisher's final edited version of this article is available at Curr Osteoporos Rep See other articles in PMC that cite the published article. Diabetes mellitus is a metabolic disorder that increases fracture risk and interferes with bone formation and impairs fracture healing. Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) both increase fracture risk and have several common features that affect bone including hyperglycemia and increased AGE formation, ROS generation, and inflammation. These factors affect both osteoblasts and osteoclasts lead to increased osteoclasts and reduced numbers of osteoblasts and bone formation. In addition to fracture healing, T1DM and T2DM impair bone formation under conditions of perturbation such as bacteria induced periodontal bone loss, which reduces expression of factors that stimulate osteoblasts such as BMPs and growth factors and increase osteoblast apoptosis. Keywords: diabetes, inflammation, advanced glycation end-products (AGE), oxidative stress, Insulin, Hyperglycemia, osteoblast, osteoclast, fracture healing Diabetes mellitus (DM) is a chronic metabolic disease with hi Continue reading >>

Diabetes: Stimulating Bone Stem Cells May Improve Fracture Repair

Diabetes: Stimulating Bone Stem Cells May Improve Fracture Repair

Diabetes: Stimulating bone stem cells may improve fracture repair Researchers have discovered a protein that stimulates bone stem cells in mice with diabetes so that the animals heal better after a fracture. They suggest that this could lead to a new treatment to improve bone repair in people with diabetes. Bones of normal mice (top) form larger calluses during healing, which lead to stronger repair. However, bones of diabetic mice (bottom) have smaller calluses, which lead to more brittle healed bones. The team, from Stanford University School of Medicine in Palo Alto, CA, reports the findings in the journal Science Translational Medicine. Michael T. Longaker, a professor of plastic and reconstructive surgery and one of the study's senior authors, sums up the work: "We've uncovered the reason why some patients with diabetes don't heal well from fractures, and we've come up with a solution that can be locally applied during surgery to repair the break." Diabetes is a chronic disease that occurs when the body's ability to produce or respond to insulin - a hormone that regulates blood sugar - is impaired. Raised blood sugar (hyperglycemia) is a common effect of uncontrolled diabetes, and over time it can cause serious damage in many parts of the body, including the heart, blood vessels, eyes, kidneys, and nerves. Today, there are more than 420 million people with diabetes worldwide - nearly four times as many as there were in 1980 (108 million). Problematic bone healing is one of the many health complications that people with diabetes experience; following a break or fracture , their bones may heal poorly. "Diabetes is rampant worldwide," says Prof. Longaker, "and any improvement in the ability of affected people to heal from fractures could have an enormously positive e Continue reading >>

Diabetes And Its Effect On Bone And Fracture Healing.

Diabetes And Its Effect On Bone And Fracture Healing.

Diabetes and Its Effect on Bone and Fracture Healing. Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. Curr Osteoporos Rep. 2015 Oct;13(5):327-35. doi: 10.1007/s11914-015-0286-8. Diabetes mellitus is a metabolic disorder that increases fracture risk, interferes with bone formation, and impairs fracture healing. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) both increase fracture risk and have several common features that affect the bone including hyperglycemia and increased advanced glycation end product (AGE) formation, reactive oxygen species (ROS) generation, and inflammation. These factors affect both osteoblasts and osteoclasts leading to increased osteoclasts and reduced numbers of osteoblasts and bone formation. In addition to fracture healing, T1DM and T2DM impair bone formation under conditions of perturbation such as bacteria-induced periodontal bone loss by increasing osteoblast apoptosis and reducing expression of factors that stimulate osteoblasts such as BMPs and growth factors. Continue reading >>

The Impact Of Type 2 Diabetes On Bone Fracture Healing

The Impact Of Type 2 Diabetes On Bone Fracture Healing

The Impact of Type 2 Diabetes on Bone Fracture Healing 1Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium 2PrometheusDivision of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium 3BiomaterialsBIOMAT, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium 1Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium 2PrometheusDivision of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium 1Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium 2PrometheusDivision of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium 2PrometheusDivision of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium 3BiomaterialsBIOMAT, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium 1Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium 2PrometheusDivision of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium 3BiomaterialsBIOMAT, Department of Oral Health Sciences, KU Leuven, Leuven, Belgium 4Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium Edited by: Ann Schwartz, University of California, San Francisco, United States Reviewed by: Nicola Napoli, Universit Campus Bio-Medico, Italy; Beata Lecka-Czernik, University of Toledo, United States *Correspondence: Katleen Vandamme, [email protected] Specialty section: This article was submitted to Bone Research, a section of the journal Frontiers in Endocrinology Received 2017 Sep 19; Accepted 2018 Jan 5. Copyright 2018 Marin, Luyte Continue reading >>

The Impact Of Type 2 Diabetes On Bone Fracture Healing.

The Impact Of Type 2 Diabetes On Bone Fracture Healing.

The Impact of Type 2 Diabetes on Bone Fracture Healing. 1.Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. 2.Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium. 3.Prometheus-Division of Skeletal Tissue Engineering Leuven, KU Leuven, Leuven, Belgium. Frontiers in Endocrinology [24 Jan 2018, 9:6] Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing. Continue reading >>

The Impact Of Diabetes On Bone Health

The Impact Of Diabetes On Bone Health

Diabetes care revolves around controlling blood sugar (glucose) to reduce what we recognize as diabetes complications those relating to vision, to nerve function, to kidney function and to the vessels of the heart, vessels leading to the brain, and the vessels in the legs. What is not so well recognized is that there is also an issue of bone health when most people think of possible complications of diabetes. Osteoporosis is a condition in which there is generalized thinning and weakening of your bones, which puts you at risk of a bone fracture. Osteoporosis is very common, affecting nearly 10 million Americans. Among all Caucasian women, one out of every two have a risk of having an osteoporosis-associated fracture in their lifetime. It doesnt help that as we all get older, bone health plays a larger and larger role for everyone, even more so if you have also been diagnosed with diabetes. Diabetes adds to an increased risk of fractures. And having diabetes can delay fracture healing if fracture occurs, a double hit. But how does diabetes affect the quality of bone and increase the risk of fracture? Is it just diabetes itself, or other complications of diabetes such as neuropathy (nerve damage)? Or is it the medications that are used to control blood sugars? Lets look at the evidence. What is the link between bone density and diabetes? Bone mineral density (BMD) measures the calcium content of the bone, predicting bone strength and fracture risk. The lower the bone density, the higher the risk of fracture. BMD is measured by a special scan called dual-energy X-ray absorptiometry (DXA). BMD as measured by DXA is decreased in Type 1 diabetes (T1D, the diabetes in which your pancreas does not make insulin), but may be actually normal or even increased in Type 2 diabetes ( Continue reading >>

The Link Between Diabetes And Fractures - What To Ask Your Doctor

The Link Between Diabetes And Fractures - What To Ask Your Doctor

The Link Between Diabetes and Fractures - What to Ask Your Doctor Did you know that people with diabetes are at greater risk for bone fractures? A fracture is defined as any broken bone. Bones break when outside force(s) are applied which are greater than the strength of the bone. Bones can break crosswise, lengthwise or in pieces.(1) We will explore the results of five studies linking diabetes with an increased risk for fractures. Questions to ask your physician about fracture prevention are also included to help you stay healthy. Five studies linking diabetes and fractures: 1.The Prospective Study of Diabetes and Risk of Hip Fractures (The Nurses Health Study) was published in 2006. This study followed 109,983 women between the ages of 34-59 with and without diabetes for approximately 20 years. People with diabetes (type 1 or type 2) were associated with having an increased risk for hip fractures. Fracture prevention strategies for women with diabetes were recommended.(2) 2. The Diabetes and Risk of Fracture-Related Hospitalization: The Atherosclerosis Risk in Communities Study was published in 2012. (3,4) This study reviewed fracture related hospitalizations at four large community hospitals and included; leg, ankle, arm, ribs, spine, skull and face, hip, hand, shoulder, wrist and foot fractures. There were 1,078 incidents of fracture related hospitalizations examined during a median of 20 years follow-up. The study involved 15,140 subjects between the ages of 45-64 years.Fractures that did not result in an inpatient hospitalization were excluded in the numbers.Subjects with diagnosed diabetes had a significantly increased risk of having fractures. People with diabetes who needed insulin therapy and those with hemoglobin A1c levels equal or higher than 8 percent wer Continue reading >>

Diabetes Affects Fracture Healing At Cellular Level

Diabetes Affects Fracture Healing At Cellular Level

Patients with diabetes are at increased risk for delayed union or nonunion following skeletal trauma or elective orthopedic surgery, due to impaired osseous regeneration. Researchers are investigating the underlying etiologies in an effort to find therapeutic solutions. By David N. Paglia MS, Siddhant K. Mehta BS, Kristen Mason BS, Eric A. Breitbart MD, Aaron Wey BS, Andrew Park MS, Swaroopa Vaidya MS, Ravi Verma BS, Dana Graves PhD, J. Patrick O’Connor PhD, and Sheldon S. Lin MD In the United States, more than 21 million people suffer from diabetes mellitus (DM), a systemic disease resulting in impaired glucose homeostasis. With a better understanding of its underlying pathophysiology, additional therapeutic regimens have been developed that optimize blood glucose control, resulting in a longer life span in the diabetic patient. As such, other secondary issues linked to DM are now surfacing, including the association between DM and impaired osseous healing. Several retrospective studies have evaluated complications following elective arthrodesis in DM patients.1-3 Although the patients in these studies represented a sub-population with diabetic neuropathy, the noted increase in incidence of delayed union, nonunion, and pseudoarthrosis was significant in DM patients.1-3 Perlman and Thordarson4 compared the results of ankle fusion in several nonunion risk groups. They found a higher incidence of nonunion after attempted arthrodesis in DM patients compared to non-DM patients, with three of eight attempted arthrodeses in non-neuropathic DM patients resulting in nonunion compared to a 28% nonunion rate in the overall study population. Another study analyzed the predisposing factors contributing to nonunion after ankle arthrodesis. Non-neuropathic patients with major medic Continue reading >>

How To Treat Ankle Fractures In Patients With Diabetes

How To Treat Ankle Fractures In Patients With Diabetes

How To Treat Ankle Fractures In Patients With Diabetes By Alan R. Catanzariti, DPM, Robert W. Mendicino, DPM, and Travis L. Sautter, DPM Ankle fractures in patients with diabetes and documented neuropathy present a significant challenge to the clinician. The majority of literature has indicated that ankle fractures in this particular patient population are often difficult to manage and complication rates are reportedly quite high. These poor outcomes are similar for both conservative and surgical treatment. There are several factors implicated in the high complication rates one sees in the management of ankle fractures in patients with diabetic neuropathy. Many of these patients have significant osteopenia. The combination of the osteopenia with neuropathy can often result in significant problems. Treatment for these patients is often very labor-intensive and ideal therapeutic options have yet to be determined when it comes to managing ankle fractures in patients with diabetic neuropathy. Indeed, outcomes have been shown to be generally poor and some factors that have been implicated are beyond the physicians control. Standard approaches to treating these fractures in non-diabetic patients do not result in good outcomes when one applies these approaches to patients with diabetic neuropathy. Clinicians should also be aware of significant medical and legal issues surrounding the treatment of diabetic ankle fractures. What You Should Know About The Risk Factors Cavanaugh, et. al., presented a study evaluating radiographic abnormalities in patients with diabetic neuropathy. They noted a substantial number of neuropathic fractures in a large number of these patients and also pointed out that a significant number of patients went on to develop a Charcot process. The authors Continue reading >>

Enhancing Bone Healing In Diabetics

Enhancing Bone Healing In Diabetics

News Jan 13, 2017| Original story from Stanford University Bone fractures in diabetic mice heal better in the presence of a protein that stimulates the activity of skeletal stem cells, according to a study by researchers at the Stanford University School of Medicine. The protein counteracts a decrease in stem cell activity that the researchers observed both in mouse models of diabetes and in bone samples from diabetic patients who had undergone joint replacements. The researchers hope the discovery will lead to ways to help people with diabetes heal more efficiently from broken bones. Weve uncovered the reason why some patients with diabetes dont heal well from fractures, and weve come up with a solution that can be locally applied during surgery to repair the break, said Michael Longaker, MD, co-director of Stanfords Institute for Stem Cell Biology and Regenerative Medicine. Diabetes is rampant worldwide, and any improvement in the ability of affected people to heal from fractures could have an enormously positive effect on their quality of life. Diabetes mellitus is a metabolic disease characterized by the inability to either produce or to respond appropriately to insulin. It affects hundreds of millions of people worldwide and is increasing in prevalence. In addition to causing dangerous swings in blood sugar levels after meals, the condition leads to many other debilitating symptoms, including an impaired ability to heal soft tissue injuries and skeletal fractures. The precise molecular reason behind this impaired bone healing has been unknown, however. Longaker, Chan and Tevlin built on previous research in which they and colleagues in the laboratory of Irving Weissman, MD, professor of pathology and of developmental biology, identified and described a population 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 >>

Type 2 Diabetes And Bone Fracture Healing Time

Type 2 Diabetes And Bone Fracture Healing Time

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Type 2 diabetes and bone fracture healing time I am a type 2 diabetic, on Metformin. 8 weeks ago I managed to fracture my finger, and have had to wear a splint for that amount of time. I was told I should wear it for 6 - 8 weeks at the fracture clinic, but now, having removed it, I find it still misshapen, swollen and painful if I touch it. I only have to attend the fracture clinic again on 19th Jan. if I have problems, otherwise I should cancel the appointment. Can anyone tell me whether it takes longer for fractures to heal if you are type 2 diabetic, or if this is what I should expect and is the norm. If it appears mis-shapen then perhaps you need another X-ray to determine whether it has,in fact ,healed up in the correct position.Having been in a splint for a while it will take quite a lot of gentle exercise to get the joint working again.Once the joint is being used then the swelling should also go down. the tighter your BG control is to non-diabetic levels, during the healing, the quicker it will be. That means keeping around 5 at ALL times. Ask for plenty of test strips and "eat to your meter". They should let you have strips under these circumstances. The consequences of imperfect healing are horrible.( SORRY!!!!) It takes most things longer to heal if your BG is too high. Having said which I have a few horror stories about unhealed fractures/dislocations in nondiabetics too, any problems *definitely* go back and see them ASAP. Thanks for the information. Much appreciated. I, stumbled on this thread whilst looking for something else but thought I'd put in my threepenneth worth. I had a road accident in 1999 and ended up with srews and plates i Continue reading >>

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