Musculoskeletal manifestations of diabetes mellitus – an update

Abstract

• Musculoskeletal conditions associated with diabetes are under-appreciated and contribute significant morbidity for patients. Generally, improved glycaemic control, a balanced diet with reduced saturated fat intake and regular exercise reduce the risk of these conditions. • Fibrosing musculoskeletal conditions and internal organ fibrosis are more common in diabetes. • Patients with type 2 diabetes are at higher risk of fracture despite a normal bone mineral density. This risk is better predicted by FRAXplus and QFracture risk prediction tools. • Patients with type 2 diabetes presenting with metabolic syndrome have an increased risk of musculoskeletal complications due to chronic inflammation, oxidative stress and obesity sarcopenia. • Type 1 diabetes is associated with other autoimmune conditions such as stiff person syndrome and rheumatoid arthritis. Diabetes mellitus is an increasingly prevalent condition, with an estimated 1.3 billion people projected to be affected by 2050, and can reduce life expectancy by up to 20 years. Musculoskeletal complications are present in more than half of patients with diabetes and lead to significant morbidity and disability. Diabetes increases chronic inflammation, reduces anabolism and compromises blood supply to bones, muscles and joints. This can cause fibrosis of tendons and joints, impaired quality of bone and muscle production and, in some instances, local joint destruction. The risk is further increased in patients with overlapping metabolic syndrome. Musculoskeletal complications promote a sedentary lifestyle and worsen the trajectory of diabetes management. Here, we provide an update on the musculoskeletal manifestations of diabetes and their treatments since our review in 2015.

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