Musculoskeletal disorders associated with diabetes

Abstract Several musculoskeletal diseases are prevalent in individuals with diabetes. These include ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. In both, heterotopic ossification near the spine underlies neurological injury. These related conditions are common in individuals with obesity and type 2 diabetes; and, in both, abnormal mesenchymal cell differentiation secondary to altered growth factor milieu has been implicated in pathogenesis. Similarly, two shoulder disorders—rotator cuff tendinopathy and adhesive capsulitis—cause tendon injury and fibrosis. Common in those with type 1 and 2 diabetes, they are respectively thought to be caused by advanced glycation end product deposition and myofibroblastic differentiation of tendon mesenchymal cells. Finally, diabetic amyotrophy is rare, painful diabetic neuropathy associated with muscle wasting and likely caused by immune-mediated microvasculitis. Better understanding of their relationships with metabolic dysfunction may further elucidate the pathogenic mechanism of these conditions and inform future treatment options.