Author: Rejnmark, Lars

Source: Current Drug Safety, Volume 3, Number 3, September 2008 , pp. 194-198(5)

Publisher: Bentham Science Publishers

Abstract:

Several lines of evidence suggest that diabetes causes harmful effects on bone. This may be due to the diabetic disease per se i.e., high as well as low insulin and glucose levels may cause direct effects on bone metabolism. Moreover, diabetes associated co-morbidity, including impaired vision and neuropathy may affect physical activity and postural stability with effects on bone mineral density (BMD) and fracture risk. In type 1 diabetes, a 7-fold increase in risk of fracture has been reported but there is controversy about whether risk of fracture can be reduced by tight glycaemic control. However, the increased fracture risk seems at least in part to be associated with complications of diabetes, and therefore good metabolic control may reduce the risk of fracture in the long term. Risk of fracture is also increased in type 2 diabetes, but there are no good-quality studies comparing effects on bone of insulin with oral anti-diabetic agents. However, there are differences between bone effects of different oral anti-diabetic drugs. From a bone perspective, metformin and sulphonylureas should be chosen rather than glitazones, as randomised trials have shown that glitazones decrease BMD and increase fracture risk. The mechanism of action is probably through decreased bone formation. Conversely, metformin and sulphonylureas may counter the harmful bone effects of diabetes, as risk of fracture in patients treated with these drugs seems to be reduced compared with the general population. Studies are needed to elucidate mechanisms of action by which metformin and sulphonylureas may affect bone.

Keywords: Diabetes; glitazones; metformin; sulphonylureas; insulin; bone; fracture

Document Type: Research article

DOI: http://dx.doi.org/10.2174/157488608785699478

Publication date: 2008-09-01

More about this publication?

• Current Drug Safety publishes frontier reviews on all the latest advances on drug safety. The journal's aim is to publish the highest quality review articles in the field. Topics covered include: adverse effects of individual drugs and drug classes, management of adverse effects, pharmacovigilance and pharmacoepidemiology of new and existing drugs, post-marketing surveillance. The journal is essential reading for all researchers and clinicians involved in drug safety.

Related content

• In this: publication
• By this: publisher
• In this Subject: Pharmacology
• By this author: Rejnmark, Lars

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers