New insights on diabetes and bone metabolism.

Diabetes mellitus is a common chronic metabolic disease worldwide whose prevalence has increased during the last decades. Besides its more commonly recognized complications, such as macrovascular disease, retinopathy, nephropathy and neuropathy, diabetes related bone disease has gained growing attention. Diabetic patients are more prone to fracture than the general population as well as to low turnover bone disease in the chronic kidney disease setting. In this review, we discuss the relationship between diabetes and bone as well as the pathogenesis of bone fragility in T2D.

New insights on diabetes and bone metabolism / Novos conceitos em diabetes e metabolismo ósseo

Diabetes mellitus is a common chronic metabolic disease worldwide whose prevalence has increased during the last decades. Besides its more commonly recognized complications, such as macrovascular disease, retinopathy, nephropathy and neuropathy, diabetes related bone disease has gained growing attention. Diabetic patients are more prone to fracture than the general population as well as to low turnover bone disease in the chronic kidney disease setting. In this review, we discuss the relationship between diabetes and bone as well as the pathogenesis of bone fragility in T2D.

Resumos O diabetes mellitus é uma desordem metabólica crônica cuja prevalência tem aumentado no mundo todo ao longo das últimas décadas. Além de suas complicações mais reconhecidas, como a doença macrovascular, retinopatia, nefropatia e neuropatia, as alterações ósseas relacionadas ao diabetes têm ganhado um crescente interesse. Os pacientes diabéticos são mais suscetíveis a fraturas do que a população geral e à doença de baixa remodelação entre os pacientes com doença renal crônica. Nesta revisão, iremos discutir a relação entre diabetes e o tecido ósseo, assim como a patogênese da fragilidade óssea no diabetes tipo 2.

Skeletal microstructural abnormalities in postmenopausal women with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and fragility fractures. The objectives of this study were to assess static and dynamic indices of cancellous and cortical bone structure in postmenopausal women with COPD. Twenty women with COPD who had not received chronic oral glucocorticoids underwent bone biopsies after double tetracycline labeling. Biopsies were analyzed by histomorphometry and µCT and compared with age-matched controls. Distribution of the patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was: Type I (15%), Type II (40%), Type III (30%), and Type IV (15%). Mean (±SD) cancellous bone volume (15.20 ± 5.91 versus 21.34 ± 5.53%, p = .01), trabecular number (1.31 ± 0.26 versus 1.77 ± 0.51/mm, p = .003), and trabecular thickness (141 ± 23 versus 174 ± 36 µm, p = .006) were lower in patients than in controls. Connectivity density was lower in COPD (5.56 ± 2.78 versus 7.94 ± 3.08/mm, p = .04), and correlated negatively with smoking (r = -0.67; p = .0005). Trabecular separation (785 ± 183 versus 614 ± 36 µm, p = .01) and cortical porosity (4.11 ± 1.02 versus 2.32 ± 0.94 voids/mm(2); p < .0001) were higher in COPD while cortical width (458 ± 214 versus 762 ± 240 µm; p < .0001) was lower. Dynamic parameters showed significantly lower mineral apposition rate in COPD (0.56 ± 0.16 versus 0.66 ± 0.12 µm/day; p = .01). Patients with more severe disease, GOLD III and IV, presented lower bone formation rate than GOLD I and II (0.028 ± 0.009 versus 0.016+ 0.011 µm(3)/µm(2)/day; p = 04). This is the first evaluation of bone microstructure and remodeling in COPD. The skeletal abnormalities seen in cancellous and cortical bone provide an explanation for the high prevalence of vertebral fractures in this disease.

Bone histomorphometry: a concise review for endocrinologists and clinicians.

Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Bone histomorphometric parameters are divided into structural and remodeling subgroups, with the latter being subdivided into static and dynamic categories. Metabolic bone disorders such as osteomalacia, hyperparathyroidism, hypothyroidism, osteoporosis and renal osteodystrophy display different histomorphometric profiles. Antiresorptive and anabolic drugs used for the treatment of osteoporosis also induce characteristic changes in the bone biopsy. Bone histomorphometry is an important research tool in the field of bone metabolism and provides information that is not available by any other investigative approach.

Bone histomorphometry: a concise review for endocrinologists and clinicians / Histomorfometria óssea: uma revisão concisa para endocrinologistas e clínicos

Bone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Bone histomorphometric parameters are divided into structural and remodeling subgroups, with the latter being subdivided into static and dynamic categories. Metabolic bone disorders such as osteomalacia, hyperparathyroidism, hypothyroidism, osteoporosis and renal osteodystrophy display different histomorphometric profiles. Antiresorptive and anabolic drugs used for the treatment of osteoporosis also induce characteristic changes in the bone biopsy. Bone histomorphometry is an important research tool in the field of bone metabolism and provides information that is not available by any other investigative approach.

Histomorfometria óssea é uma avaliação histológica quantitativa de uma biópsia óssea calcificada realizada para obter informação sobre a remodelação e a estrutura óssea. Uma análise dinâmica é possível quando substâncias que fazem a marcação do osso são tomadas antes do procedimento e se depositam no local de formação óssea. A biópsia é indicada para diagnóstico de osteomalácia, diferentes formas de osteodistrofia renal e nos casos não explicados de fragilidade esquelética. O preparo e a análise das amostras necessitam de um laboratório especializado. A histomorfometria avalia parâmetros estruturais e de remodelação óssea, sendo o último subdividido em estático e dinâmico. Doenças osteometabólicas como osteomalácia, hiperparatireoidismo, hipoparatireoidismo, osteoporose e osteodistrofia renal apresentam parâmetros histomorfométricos distintos. Medicações antirreabsortivas e anabólicas usadas no tratamento da osteoporose também induzem alterações características na biópsia óssea. A histomorfometria óssea é uma ferramenta importante no metabolismo ósseo e oferece informação que não é possível por nenhum outro método diagnóstico.