Max Institute of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket, Delhi, India.
Max Institute of Endocrinology and Diabetes, Max Super Speciality Hospital, Saket, Delhi, India.
Diabetes Metab Syndr. 2021 May-Jun;15(3):927-935. doi: 10.1016/j.dsx.2021.04.017. Epub 2021 Apr 24.
Diabetes and osteoporosis are common chronic disorders with growing prevalence in the aging population. Skeletal fragility secondary to diabetes increases the risk of fractures and is underestimated by currently available diagnostic tools like fracture risk assessment (FRAX) and dual-energy X-ray absorptiometry (DXA). In this narrative review we describe the relationship and pathophysiology of skeletal fragility and fractures in Type 2 diabetes (T2DM), effect of glucose lowering medications on bone metabolism and the approach to diagnosing and managing osteoporosis and bone fragility in people with diabetes (PWD).
A literature search was conducted on PubMed for articles in English that focused on T2DM and osteoporosis or bone/skeletal fragility. Articles considered to be of direct clinical relevance to physicians practicing diabetes were included.
T2DM is associated with skeletal fragility secondary to compromised bone remodeling and bone turnover. Long duration, poor glycemic control, presence of chronic complications, impaired muscle function, and anti-diabetic medications like thiazolidinediones (TZD) are risk factors for fractures among PWD. Conventional diagnostic tools like DXA and FRAX tool underestimate fracture risk in diabetes. Presence of diabetes does not alter response to anti-osteoporotic treatment in post-menopausal women.
Estimation of fragility fracture risk should be included in standard of care for T2DM along with screening for traditional complications. Physicians should proactively screen for and manage osteoporosis in people with diabetes. It is important to consider effects on bone health when selecting glucose lowering agents in people at risk for fragility fractures.
糖尿病和骨质疏松症是常见的慢性疾病，在老龄化人口中患病率不断上升。糖尿病引起的骨骼脆弱会增加骨折的风险，而目前可用的骨折风险评估（FRAX）和双能 X 射线吸收法（DXA）等诊断工具对此估计不足。在本叙述性综述中，我们描述了 2 型糖尿病（T2DM）中骨骼脆弱和骨折的关系和病理生理学、降血糖药物对骨代谢的影响，以及诊断和管理糖尿病患者（PWD）骨质疏松症和骨骼脆弱的方法。
在 PubMed 上对聚焦于 T2DM 和骨质疏松症或骨骼/骨骼脆弱的英文文章进行了文献检索。纳入了被认为与实践糖尿病的医生直接相关的临床文章。
T2DM 与骨骼脆弱有关，这是由于骨重塑和骨转换受损所致。糖尿病患者骨折的危险因素包括病程长、血糖控制不佳、存在慢性并发症、肌肉功能受损以及噻唑烷二酮类（TZD）等抗糖尿病药物。DXA 和 FRAX 等常规诊断工具低估了糖尿病患者的骨折风险。糖尿病的存在并不改变绝经后妇女对抗骨质疏松治疗的反应。
在 T2DM 的标准治疗中应包括脆性骨折风险的评估，同时筛查传统并发症。医生应积极筛查和管理糖尿病患者的骨质疏松症。在有脆性骨折风险的人群中选择降血糖药物时，考虑其对骨骼健康的影响非常重要。
