Effetti dei nuovi farmaci incretinici sulla salute dell’osso

Diabetes mellitus is a chronic disease, the complications of which (specific and non-specific) contribute to reducing the quality of life and life expectancy of people affected by the disease. Considering the longer life expectancy of individuals with diabetes and the present available therapeutic options (or those available in the immediate future), the loss of bone mass and bone fragility represent one of the most important aspects among diabetes-related comorbidities. In fact, diabetes is a strong predisposing condition for the development and worsening of osteoporosis, affecting both the young and adult populations. Both type 1 and type 2 diabetes are associated with abnormalities in bone mass and an increased risk of fractures. Among the recent developments in the pharmacological landscape for the treatment of type 2 diabetes mellitus (T2DM), GLP-1 Receptor Agonists (GLP-1 RAs) are now one of the most effective options, as they are capable, among other effects, of stimulating insulin secretion in a glucose-dependent manner, protecting the function of $\beta$ $\beta $ cells, and suppressing glucagon secretion. Although a negative impact on bone mass was expected (due to weight loss over a relatively short period), it has been reported that GLP-1 RAs can increase bone mineral density (BMD), improve bone quality, and prevent fractures in people with diabetes, particularly in cases of postmenopausal, glucocorticoid-induced, and senile osteoporosis. Considering the advent of dual and triple agonists, it would be desirable to incorporate the potential impact on bone health of the antidiabetic drugs among various and classic characteristics (cardiovascular prevention, renal safety, weight effect, risk of hypoglycaemia, etc.).