Assessment and treatment of osteoporosis and fractures in type 2 diabetes

There is substantial, and growing, evidence that type 2 diabetes (T2D) is associated with skeletal fragility, despite often preserved bone mineral density. As post-fracture outcomes, including mortality, are worse in people with T2D, bone management should be carefully considered in this highly vulnerable group. However, current fracture risk calculators inadequately predict fracture risk in T2D, and dedicated randomised controlled trials identifying optimal management in patients with T2D are lacking, raising questions about the ideal assessment and treatment of bone health in these people. We synthesise the current literature on evaluating bone measurements in T2D and summarise the evidence for safety and efficacy of both T2D and anti-osteoporosis medications in relation to bone health in these patients.

Automated summary

There is substantial evidence linking type 2 diabetes to skeletal fragility, despite preserved bone mineral density. The post-fracture outcomes in diabetic patients are worse, raising questions about the ideal assessment and treatment of bone health. Current fracture risk calculators are not effective in predicting fracture risk in these patients, and there is a lack of dedicated randomized controlled trials to identify optimal management for patients with type 2 diabetes.