Molecular Modulation of Osteoblasts and Osteoclasts in Type 2 Diabetes

Table 1

Effects of antidiabetic drugs on bone metabolism.

Antidiabetic drugs	Mode of action	References
Amylin	At low concentrations ⬇ osteoclastogenesis	[90]
Incretin	⬇ GLP-1 receptors; ⬆ GIP influence on bone resorption and bone formation	[30, 71, 86]
Insulin	⬆ Bone formation	[87–89]
Metformin	⬇ Indigenous glucose production; ⬆ insulin sensitivity; ⬆ osteogenic markers	[31, 51, 78, 79, 80–82]
Sodium glucose cotransporter inhibitors	Interferes with calcium and phosphate homeostasis; ⬆ CTX and ⬇ BMD	[91, 92]
Sulfonylureas	⬇ CTX, NTX; ⬆ ALP, osteocalcin, bone strength	[30, 81, 83]
Thiazolidinediones	⬆ Adipogenesis; ⬇ BMD	[31]

⬆ = increases; ⬇ = decreases. GLP-1 = Glucogon like peptide 1, GIP = G;ucose-dependent insulinotropic polypeptide, CTX = C-terminal telopeptide, NTX = N-terminal telopeptide, BMD = bone mineral density, ALP = alkaline phosphatase.