Table 4.
Serum markers with potential role for fracture risk assessment in diabetes
| Marker | Tissue of origin | Role in diabetic bone | Potential use for fracture prediction |
|---|---|---|---|
| Glycemia (HbA1c) |
Erythrocytes | Collagen glycosylation Fracture risk prediction |
Yes (fracture data) |
| Bone turnover marker (PINP, CTX) | Collagen formation/degradation | State of low turnover Evaluation of treatment efficacy |
No predictive value |
| AGEs (pentosidine) | Collagen cross-linking | Impair bone properties by accumulation in bone collagen | Potentially (limited fracture data) |
| Sclerostin | Osteocyte | Higher sclerostin gene expression in DM | Potentially (no fracture data) |
| IGF-1 | Hepatocyte | Osteoblast stimulation | Yes (fracture data) |
| Calciotropic hormones (eg, PTH) | Parathyroid cells | Calcium homeostasis | Potentially (limited fracture data) |
| Proinflammatory cytokines (eg, TNFα, IL-1, -6, -11, CRP) |
Inflammation | Alteration of bone remodeling | Potentially (limited fracture data) |
| Vascular markers (eg, VEGF) | Bone marrow | Bone marrow cell apoptosis | No fracture data |
| Adipokines (eg, leptin, adiponectin) |
Adipose tissue | Regulation of osteoblast function | No fracture data |
Abbreviations: AGEs, advanced glycation end products; CRP, C-reactive protein; CTX, C-terminal telopeptide of type I collagen; DM, diabetes mellitus; HbA1c, glycated hemoglobin A1c; IGF-1, insulin-like growth factor-1; IL, interleukin; PINP, procollagen type 1 amino-terminal propeptide; PTH, parathyroid hormone; TNFα, tumor necrosis factor α; VEGF, vascular endothelial growth factor.