NOTCH2 and Hyperglycemia: Hyperglycemia and HbA1c may impede the formation of osteoblasts from mesenchymal progenitors by activating the Notch2 signaling pathway.[43] The accumulation of advanced glycation end products may result in a decrease in bone turnover, alterations in bone microarchitecture, and an elevated risk of fracture among diabetic patients.[44–47]