Diagnosis and management of bone fragility in diabetes: an emerging challenge
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Springer London
Abstract
Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk. © 2018, The Author(s).
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Keywords
Diabetes, Diabetes-related bone disease, Fracture, Osteoporosis, Bone density conservation agents, Bone remodeling, Diabetes mellitus, type 1, Diabetes mellitus, type 2, Humans, Osteoporotic fractures, Risk factors, Abaloparatide, Advanced glycation end product, Advanced glycation end product receptor, Alendronic acid, Carboxy terminal telopeptide, Denosumab, Dipeptidyl peptidase iv inhibitor, Etidronic acid, Glitazone derivative, Glucagon like peptide 1 derivative, Incretin, Insulin, Metformin, Osteocalcin, Parathyroid hormone[1-34], Procollagen type i n terminal propeptide, Protein precursor, Raloxifene, Risedronic acid, Romosozumab, Sclerostin, Sulfonylurea derivative, Unclassified drug, Bone density conservation agent, Biochemical analysis, Bone density, Bone fragility, Bone microarchitecture, Bone quality, Bone structure, Bone turnover, Clinical feature, Diabetes mellitus, Diabetic patient, Disease duration, Drug effect, Dual energy x ray absorptiometry, Echography, Fragility fracture, Frax score, Glycemic control, High risk population, Human, Lifestyle modification, Major osteoporotic fracture, Morphometry, Musculoskeletal system parameters, Non insulin dependent diabetes mellitus, Priority journal, Review, Risk assessment, Risk factor, Scoring system, Trabecular bone score, Complication, Insulin dependent diabetes mellitus, Pathophysiology