The following is a summary of “Bone Health in Patients With Type 2 Diabetes,” published in the July 2024 issue of Endocrinology by Forner, et al.
The relationship between type 2 diabetes mellitus (T2DM) and skeletal fragility is intricate, affecting bone at cellular, molecular, and biomechanical levels. Despite often maintaining normal bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA), individuals with T2DM are at heightened risk of fractures. This paradox arises from maladaptive skeletal loading and alterations in bone architecture (especially cortical porosity and reduced cortical volumes, characteristic of diabetic osteopathy), which are not readily discernible on routine DXA scans. Advanced imaging techniques such as quantitative computed tomography and trabecular bone score offer insights into cortical and trabecular compartments, potentially aiding in identifying individuals prone to fracture.
Conventional fracture risk calculators, reliant on BMD, frequently underestimate fracture risk in T2DM. Consequently, individuals with T2DM who face increased fracture susceptibility may not qualify for osteoporosis treatment initiation. Optimal management of skeletal health in T2DM necessitates considering commencing therapy at lower BMD thresholds, utilizing adjusted fracture risk assessment tools, and evaluating metabolic and non-skeletal risk factors. The choice of antidiabetic medications is critical, as they exert variable effects on bone metabolism, influencing treatment decisions for those at fracture risk.
Assessing bone health and fracture risk in T2DM presents unique challenges. The study explored the clinical burden and manifestation of skeletal disease in T2DM. Two clinical cases were presented to illustrate an approach to evaluating and managing fracture risk in these patients.
Reference: academic.oup.com/jes/article/8/7/bvae112/7688851
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