Managing Bone Fragility in Older Adults with Diabetes: Pathophysiology, Assessment, and Therapeutic Considerations
Abstract
Older adults with diabetes mellitus, encompassing both type 1 diabetes (T1D) and type 2 diabetes (T2D), face a substantially elevated risk of fragility fractures, contributing significantly to morbidity and mortality in this vulnerable population. The underlying pathophysiology differs between the two types: T1D is typically characterized by reduced bone mineral density (BMD) stemming from insulinopenia, whereas T2D often presents with normal or even high BMD but compromised bone quality due to factors, including altered microarchitecture, accumulation of advanced glycation end products (AGEs), and low bone turnover. These distinct mechanisms create challenges for accurate fracture risk assessment, as standard tools such as dual-energy X-ray absorptiometry (DXA)-measured BMD and the Fracture Risk Assessment Tool (FRAX) often underestimate the true risk, particularly in T2D. Effective management necessitates a comprehensive, individualized approach. This includes optimizing glycemic control while minimizing hypoglycemia, implementing lifestyle modifications such as adequate nutrition (calcium, vitamin D, protein) and appropriate exercise, and crucially, proactive fall prevention strategies. Careful consideration must be given to the selection of antidiabetic medications, avoiding agents known to harm bone (e.g., thiazolidinediones) and preferring those with neutral or potentially beneficial skeletal effects (e.g., metformin, dipeptidyl peptidase-4 inhibitors [DPP-4i],…
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.