Mechanistic implications of diabetes leading to bone pathology

Abstract

Diabetes, both hypoglycemia and/or hyperglycemia has deleterious impact leading to cardiovascular complications, irregularities in bone homeostasis and modelling processes. It affects bones by interfering with the formation of osteoblasts from mesenchymal stem cells (MSCs) and also by disturbing the mineral density and its microarchitecture. Osteocalcin, advanced glycation end products (AGEs), mutated Wnt receptor (LRP6) plays a significant role in diabetes induced bone and joint damage. Rheumatoid and osteoarthritis are both directly affected by diabetes; however, osteoporosis, ACL (anterior cruciate ligament) etc. too are indirectly altered by diabetes. Not only diabetes as a disease affect bones; the anti-diabetic medications also has a negative effect on bone and joint health, especially thiazolidinediones. However, some therapeutics do have a positive impact on bone health like incretins, metformin, insulin etc. Changes in sedentary lifestyle by the subjects and their weight control strategies have resulted in significant improvement in glucose control and bone health. This review highlights the link between diabetes and bone and joint health and the positive as well as negative impact of the disease in controlled and uncontrolled forms of diabetes on the healthy joints and bones of an individual.