Taiwan joint consensus on the management of osteoporosis in patients with diabetes

Diabetes mellitus is increasingly recognized as a major contributor to skeletal fragility. Diabetes-related factors, including alterations in bone microarchitecture and heightened fall risk, contribute to an increased risk of fragility fractures regardless of bone mineral density. To address the distinct challenges in managing bone health in diabetes, the Taiwanese Association of Diabetes Educators, in collaboration with the Taiwanese Osteoporosis Association and the Endocrine Society of the Republic of China, established an expert committee to develop consensus statements based on major existing guidelines, current evidence, and expert opinion. Early screening for osteoporosis should be considered for individuals with diabetes, and adjustments to risk calculation may be needed to avoid underestimation of fracture risk. Nonpharmacologic management is a key component of optimizing bone health. Current evidence supports that anti-osteoporosis treatments demonstrate similar efficacy in individuals with and without diabetes, although certain agents may improve glycemic parameters. Selection of antihyperglycemic therapy requires consideration of potential positive or negative impact on bone mineral density and fracture risk. System-level strategies are needed to enhance multidisciplinary collaboration, heighten awareness, support systematic management, and integrate bone health into routine care. This consensus aims to provide a practical, evidence-based approach to optimize bone health in this high-risk population.