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.
Tiffany Hales
Program Manager | Diabetic 2018
Email id: diabetes@mehealthevents.org
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