二甲双胍对骨代谢的影响

糖尿病患者因骨重塑过程紊乱,使骨折风险明显增加。已证实高血糖和晚期糖基化终末产物对骨组织产生损害作用,糖尿病引起的神经系统和心血管系统合并症也可增加骨折风险。口服降糖药二甲双胍从多种途径影响糖尿病患者的骨代谢,二甲双胍可激活腺苷酸活化蛋白激酶和细胞外信号调节激酶信号通路,导致一氧化氮表达水平和骨形态发生蛋白-2表达量发生变化,影响成骨细胞的增生、分化和矿化。有研究显示,二甲双胍可逆转由高血糖和晚期糖基化终末产物引起的骨损害,并通过促进多潜能骨髓基质干细胞向成骨细胞的分化过程影响糖尿病患者的骨代谢。

Effects of metformin on bone metabolism

In recent years, a great deal of progression has been made on the skeletal health in patients with diabetes. Substantial reports have advanced our knowledge that bone remodeling is disturbed and fracture risk is much higher in diabetics. According to a body of evidence, both hyperglycemia and advanced glycation endproducts will exert harm to bone health. Diabetic associated neural and vascular complications may also contribute to increased fracture risk. As a classic oral hypoglycemic agent in diabetics, metformin has an effect on bone metabolism in the following ways ： it can activate the AMP-activated protein kinase and extracellular signal-regulated kinase signaling pathway, and then influence the expression of nitric oxide and bone morphogenetic protein-2, thus producing consequences for the proliferation, differentiation and mineralization of osteoblasts; In addition, it can also reverse the deleterious effect of hyperglycemia and advanced glycation endproducts on bone, and promote the differentiation of pluripotent bone marrow mesenchymal stem cells to osteoblasts.