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Impact of diabetes and its treatments on skeletal diseases
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《医学前沿（英文）》 2013年 第7卷 第1期 页码 81-90 doi: 10.1007/s11684-013-0243-9
Diabetes mellitus is an enormous menace to public health globally. This chronic disease of metabolism will adversely affect the skeleton if not controlled. Both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) are associated with an increased risk of osteoporosis and fragility fractures. Bone mineral density is reduced in T1DM, whereas patients with T2DM have normal or slightly higher bone density, suggesting impaired bone quality is involved. Detrimental effects of T1DM on the skeleton are more severe than T2DM, probably because of the lack of osteo-anabolic effects of insulin and other pancreatic hormones. In both T1DM and T2DM, low bone quality could be caused by various means, including but not limited to hyperglycemia, accumulation of advanced glycosylation end products (AGEs), decreased serum levels of osteocalcin and parathyroid hormone. Risk for osteoarthritis is also elevated in diabetic population. How diabetes accelerates the deterioration of cartilage remains largely unknown. Hyperglycemia and glucose derived AGEs could contribute to the development of osteoarthritis. Moreover, it is recognized that oral antidiabetic medicines affect bone metabolism and turnover as well. Insulin is shown to have anabolic effects on bone and hyperinsulinemia may help to explain the slightly higher bone density in patients with T2DM. Thiazolidinediones can promote bone loss and osteoporotic fractures by suppressing osteoblastogenesis and enhancing osteoclastogenesis. Metformin favors bone formation by stimulating osteoblast differentiation and protecting them against diabetic conditions such as hyperglycemia. Better knowledge of how diabetic conditions and its treatments influence skeletal tissues is in great need in view of the growing and aging population of patients with diabetes mellitus.
Jorge L. Escobar Ivirico, Maumita Bhattacharjee, Emmanuel Kuyinu, Lakshmi S. Nair, Cato T. Laurencin
《工程（英文）》 2017年 第3卷 第1期 页码 16-27 doi: 10.1016/J.ENG.2017.01.003
膝关节骨性关节炎(OA) 是世界上常见的关节炎，其发病率年上升。不断上涨的治疗费用给患者带来了经济负担。膝关节OA 治疗的两个早期干预目标是减轻膝关节的疼痛和关节软骨的损害。目前用于治疗膝关节OA 的方法虽取得了一定疗效，但仍没有种方法可达到全膝关节置换术(TKA) 的治疗效果TKA 主要应用于治疗末期膝关节OA，其缺点是有手术侵入性和手术费用昂贵。因而，应该重视创新性的再生术，以推迟甚至消除患者对TKA 的需求一些基于生物材料和细胞的疗法目前正处于发展阶段，并已在临床前和临床研究方面取得了初步进展单独或联合应用先进的生物材料和干细胞治疗膝关节OA 可减轻疼痛，使损害的关节软骨再生。在此综述中，我们讨论了膝关节OA 疼痛和软骨损害的发病机制，并探讨了该病的新治疗策略及其局限
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