Type 2 diabetes is associated with increased fracture risk at the hip and other sites. Surprisingly, BMD is not reduced, suggesting that diabetic bone is more fragile for a given BMD. An important clinical implication of this paradox is that BMD T-score and the FRAX algorithm underestimate fracture risk in patients with type 2 diabetes. The reasons for increased bone fragility in diabetes are not clear but some clues are emerging, including reduced bone formation rate, possible increases in cortical porosity, and higher levels of advanced glycation endproducts. Treatments for diabetes may also affect the skeleton. Options for fracture prevention in diabetic patients include glycemic control as well as established therapies for osteoporosis.
- Appreciate that BMD T-score and FRAX underestimate fracture risk in patients with type 2 diabetes.
- Identify potential reasons for increased bone fragility in diabetic patients.
- Describe current knowledge regarding fracture prevention in diabetic patients.
Length: 60 minutes