Bone Disease Associated with Diabetes Mellitus: Particularly Focusing on Its Contribution to the Development of Atherosclerosis
Bone abnormality associated with diabetes mellitus (DM) is characterized by its low bone turnover status (Krakauer et al. Diabetes 44(7):775–782, 1995). Suppression of bone turnover occurs in DM by several mechanisms, such as (i) the impaired secretion of parathyroid hormone (Inaba et al. Am J Kidney Dis 39(6):1261–1269, 2002; Inaba et al. Am J Kidney Dis 38(4 Suppl 1):S139–S142, 2001) and (ii) osteocyte/osteoblast deficit, which are caused by the sustained high glucose condition (Inaba et al. Osteoporos Int 7 (suppl 3): S209–S212, 1997) or insulin/insulin-like growth factor-1 deficiency (Wettenhall et al. Diabetes 18:280–284, 1969). Therefore, DM is recently recognized as the disease which causes often adynamic bone disease (ABD), which cause higher fracture rate in spite of no apparent reduction in bone mass (Vestergaard Osteoporos Int 18: 427–44, 2007). The decrease in the number and activity of osteeoblasts/osteocytes impaired the secretion of fibroblast growth factor (FGF)-23 from the cells (Yoda et al. J Clin Endocrinol Metab 97(11):E2036–E2043, 2012), resulting in the development of hyperphosphatemia due to phosphate overloading. Furthermore, ABD is a major risk factor for vascular calcification by diminishing the capacity of bone to adsorb surplus calcium and phosphate in circulation (London et al. J Am Soc Nephrol 15(7):1943–1951, 2004).
Therefore, it is recognized that the suppression of bone turnover with the deficit of osteocyte/osteoblast might enhance atherosclerotic change by disturbing phosphate/calcium metabolism in DM patients.
KeywordsDiabetes Bone Atherosclerosis Adynamic bone disease (ABD) FGF-23
Conflict of Interest
Masaaki Inaba declares that he has no conflict of interest.
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