Increased bone alkaline phosphatase levels do not necessarily cause hypermineralization per se

Diminished bone health and increased risk of fracture is increasingly recognised as a complication of diabetes mellitus and even as a consequence of its management. We read with interest the recently published review by Starup-Linde and Vestergaard [1] about bone turnover markers (BTMs) in patients with types 1 and 2 diabetes mellitus and their value in assessing bone health in diabetic patients. In brief, 611 eligible studies were identified of which 47 were included: 1 meta-analysis, 29 cross-sectional, 13 randomized controlled trials and 4 longitudinal studies