Type 2 diabetes and bone fragility- An under-recognized association.
Khalid J Farooqui1, Ambrish Mithal1, Ann Kwee Kerwen2
1Max Institute of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket, Delhi, India.
Diabetes & Metabolic Syndrome
|May 1, 2021
Summary
Type 2 diabetes (T2DM) increases fracture risk due to skeletal fragility, often missed by standard tools. Proactive screening and management of osteoporosis in people with diabetes are crucial for preventing fractures.
Area of Science:
- Endocrinology
- Metabolic Bone Disease
- Geriatric Medicine
Background:
- Type 2 diabetes (T2DM) and osteoporosis are prevalent, chronic conditions in aging populations.
- Diabetes-related skeletal fragility elevates fracture risk, often undetected by current tools like FRAX and DXA.
- Understanding the interplay between T2DM, bone metabolism, and fracture risk is critical.
Purpose of the Study:
- To review the pathophysiology of skeletal fragility in T2DM.
- To examine the impact of glucose-lowering medications on bone metabolism.
- To outline diagnostic and management strategies for osteoporosis in people with diabetes (PWD).
Main Methods:
- A literature search was performed on PubMed.
- Included English-language articles focusing on T2DM and osteoporosis or skeletal fragility.
- Selected articles of direct clinical relevance to diabetes practitioners.
Main Results:
- T2DM is linked to skeletal fragility via compromised bone remodeling and turnover.
- Risk factors for fractures in PWD include long duration, poor glycemic control, complications, muscle dysfunction, and certain medications (e.g., TZDs).
- DXA and FRAX underestimate fracture risk in diabetes; however, diabetes does not affect treatment response in post-menopausal women.
Conclusions:
- Fragility fracture risk assessment should be integrated into T2DM care.
- Physicians should proactively screen and manage osteoporosis in PWD.
- Consider bone health implications when choosing glucose-lowering agents for at-risk individuals.
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