Diagnosis and management of bone fragility in diabetes: an emerging challenge

S L Ferrari, B Abrahamsen, N Napoli, K Akesson, M Chandran, R Eastell, G El-Hajj Fuleihan, R Josse, D L Kendler, M Kraenzlin, A Suzuki, D D Pierroz, A V Schwartz, W D Leslie, Bone and Diabetes Working Group of IOF, S L Ferrari, B Abrahamsen, K Akesson, M S M Ardawi, M Chandran, C Cooper, R Eastell, G El-Hajj Fuleihan, R Josse, D L Kendler, M Kraenzlin, W D Leslie, A Mithal, N Napoli, A Suzuki, A V Schwartz, S L Ferrari, B Abrahamsen, N Napoli, K Akesson, M Chandran, R Eastell, G El-Hajj Fuleihan, R Josse, D L Kendler, M Kraenzlin, A Suzuki, D D Pierroz, A V Schwartz, W D Leslie, Bone and Diabetes Working Group of IOF, S L Ferrari, B Abrahamsen, K Akesson, M S M Ardawi, M Chandran, C Cooper, R Eastell, G El-Hajj Fuleihan, R Josse, D L Kendler, M Kraenzlin, W D Leslie, A Mithal, N Napoli, A Suzuki, A V Schwartz

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.

Keywords: Diabetes; Diabetes-related bone disease; Fracture; Osteoporosis.

Conflict of interest statement

S Ferrari has received research grants, honoraria, and/or consultancies from Amgen, UCB, MSD, Labatec, Agnovos. B Abrahamsen has received research contracts with Novartis and UCB with funds paid to the institution. D Kendler has received research grants, honoraria, and/or consultancies from Amgen, Eli Lilly, AstraZeneca, Pfizer. R Eastell has received research grants from Alexion, Amgen Inc., and Ultragenyx, and consulting fees from Immunodiagnostic Systems, GlaxoSmithKline, and Amgen Inc. A Suzuki has received research grants and/or honoraria from Astellas, Chugai, Daiichi-Sankyo, Kyowa-Hakko Kirin, MSD, Novo Nordisk, Ono, Pfizer, Taisho Toyama, Tanabe-Mitsubishi and Takeda. R Josse has received consultancy fees and speaker honoraria from Amgen, Lilly, Merck. K Akesson has received lecture fees or consultancies from MSD, UCB, Amgen, Eli Lilly and Sandoz. A Schwartz has received a research grant from Hologic and consulting fees from Amgen. N Napoli has received consulting fees from Lilly and Amgen. G El-Hajj Fulehain, M Chandran, DD Pierroz, M Kraenzlin have no disclosure.

Figures

Fig. 1
Fig. 1
Fracture risk evaluation in patients with diabetes. * In diabetes, fracture risk at T-score + Diabetes-specific CRFs are listed in Table 3. 1In certain countries, humerus or pelvis fractures are also sufficient to initiate therapy; otherwise, more than non-vertebral non-hip fragility fracture could be required to initiate therapy; alternatively, a non-vertebral non-hip fragility fracture should prompt further exams to evaluate fracture risk

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