Napoli et al. [21] thoroughly describe the possible mechanisms that could explain this association: in vivo and ex vivo studies have shown the anabolic effect of insulin on osteoblasts, thus hyperinsulinemia in patients with T2DM might explain the high BMD levels; also, sclerostin levels are higher among T2DM and they are positively associated with BMD. This evidence concerns the gene INS and type 2 diabetes mellitus.