Діабет-індукований остеопороз. Огляд
DOI:
https://doi.org/10.30978/CEES-2024-1-65Ключові слова:
вторинний остеопороз, гіперглікемія, діабет‑індукований остеопороз, імунопороз, цукровий діабетАнотація
В огляді літератури висвітлено вплив остеопорозу на стан здоров’я населення. Основну увагу приділено одному із видів вторинного остеопорозу — діабет‑індукованому остеопорозі. Наведено механізми втрати кісткової маси, описано взаємодію між остеобластами та остеокластами, роль імунних клітин у процесі остеопорозу за умов гіперглікемії. Визначено чинники ризику діабет‑індукованого остеопорозу при цукровому діабеті 1 та 2 типу й причини зменшення мінеральної щільності кісток.
Висока частота переломів у пацієнтів із цукровим діабетом спричинена як негативним впливом гіперглікемії на архітектоніку кістки, так і дією гіпоглікемії, що підвищує ризик падінь. Поряд з гіперглікемічно‑опосередкованими процесами в кістці в патогенезі діабет‑індукованого остеопорозу важливе значення має стан мікроциркуляторного русла, м’язової тканини та периферичної нервової системи. Поглиблене вивчення імунопорозу сприятиме створенню нових і розвитку наявних підходів до таргетного лікування остеопорозу. За даними літератури, у хворих на цукровий діабет 1 типу частота будь‑яких переломів підвищується втричі. Виявлено зв’язок гіперглікемії, інсуліну, інсуліноподібного фактора росту, анаболічних гормонів і С‑пептиду з розвитком діабет‑індукованого остеопорозу. Попри нижчу частоту переломів у хворих на цукровий діабет 2 типу порівняно з цукровим діабетом 1 типу, основними причинами переломів є високий ризик падінь, накопичення кінцевих продуктів глікозилювання, що прогресує, низький рівень метаболізму кісткової тканини, а також ожиріння та інсулінорезистентність. Схарактеризовано вплив гіпоглікемічних препаратів на ризик переломів і мінеральну щільність кісткової тканини. Метформін і агоністи рецепторів глюкагоноподібного пептиду‑1 мають найсприятливіший профіль безпечності щодо переломів у хворих на ЦД за наявності вторинного остеопорозу. У хворих на цукровий діабет найефективнішими антиостеопоротичними препаратами є бісфосфонати, андрогени та інгібітор ліганд‑рецептора активатора ядерного фактора kB (RANKL).
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