Fragility fractures are a serious yet neglected complication of both type 1 and type 2 diabetes, with enhanced risk of fragility fractures in individuals with diabetes reaching out across the life span.
This is a concern as, globally, the prevalence of diabetes in adults is expected to increase from very nearly 425 million today, to around 629 million by 2045. In the meantime, many clinicians who treat patients with diabetes are not aware of their patients' heightened risk of disabling and potentially life-threatening fractures.
Specialist stated the link between diabetes and skeletal health is complex and the optimal approach to the management of bone health in patients with diabetes is not yet definitive and may change after some time as discoveries of new clinical studies become available. This new review will inform clinicians about the present state of knowledge, and, importantly, the clear algorithm will facilitate the clinical assessment and management of fragility fracture risk in their patients according to current best practice.
The review outlines the clinical characteristics of bone fragility in adults with diabetes, and highlights recent studies that have evaluated bone mineral density, bone microstructure and biochemical markers, material properties, and fracture prediction (FRAX). It also looks at the effect of diabetes drugs on bone, and additionally the efficacy of osteoporosis treatments in these patients.
Key messages incorporate:
- FRAX and BMD T-score predict fracture risk in those with type 2 diabetes; however both require modification for diabetes to avoid underestimation of risk.
- The pathophysiology of bone delicacy in diabetes is likely multifactorial.
- If a patient has sign for treatment in view of criteria produced for non-diabetes patients, these patients should be treated with osteoporosis drugs. Without built up osteoporosis, these pharmaceuticals might be utilized, despite the fact that with caution as the impacts of these medications in situations where bone fragility is mostly because of alterations in bone quality remain to be thoroughly evaluated.
- Future studies should continue to evaluate the structural determinants (material properties, microstructure etc.) of bone fragility and refine fracture prediction algorithms by including disease-specific determinants of fracture.
- New trials will have to prospectively investigate the efficacy and safety of osteoporosis treatment in diabetics with and without low a bone mineral density.
Program Manager | Diabetic 2018
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