DPCA2-2_issue_v3

Article
Diabetes and bone health
Vidhya Jahagirdar, Neil J Gittoes
Diabetes and osteoporosis represent two major public health challenges. Osteoporosis
is characterised by decreased bone mineral density and micro-architectural changes of
the bone leading to increased risk of low trauma (fragility) fractures. Both diabetes and
osteoporosis are associated with significant morbidity, decreased quality of life and reduced
life expectancy. This article will explore the current literature on the inter-relationships
between diabetes and bone health, the impact on patients and the management strategies
that may be considered in primary care to minimise risk of diabetes-related bone disease
and improve outcomes.
Preface
Nick Forgione, General Practitioner, Trigg Health
Care Centre, Perth, WA
The connection between diabetes and
osteoporosis is often overlooked in the
busy management schedule of people
with diabetes. However, there is an accumulation
of evidence suggesting that type 2 diabetes may
be an independent risk factor for osteoporosis.
Despite the fact that bone mineral density
(BMD) is often higher in people with
type 2 diabetes compared to those without, it
is paradoxical that people with type 2 diabetes
have a higher risk of fracture. It is likely that the
explanation for this paradox is multifactorial,
including changes in trabecular bone,
microarchitectural changes in bone leading
to reduced bone strength and changes in the
material property of bone due to accumulation
of advanced glycation end products (AGEs).
Medications used in the management of diabetes
may also play a part.
Diabetes and osteoporosis represent
two major public health challenges.
Osteoporosis is characterised by
decreased bone mineral density (BMD) and
micro-architectural changes of the bone leading
to increased risk of low trauma or fragility
fractures that are sustained as a result of a fall
from standing height or less (Figure 1). Both
There is much that remains unclear about
people with diabetes-related osteoporosis.
Assessment of fracture risk must be approached
with caution as people with diabetes tend to
have a higher fracture risk for a given BMD
t-score compared to those without diabetes.
Also it is unclear whether antiresorptive agents
reduce fracture risk in type 2 diabetes to the
same extent as those without diabetes (Rubin et
al, 2013).
As the number of people with type 2 diabetes
increases and their life is extended through
improvements in management, ensuring early
detection and appropriate management of
osteoporosis in this population becomes another
priority for primary care management. Until
there is further clarification of whether or not
individuals with type 2 diabetes should be
screened and managed differently to the rest
of the population, it is important to at least
ensure that the current RACGP guidelines for
the detection and treatment of osteoporosis are
followed.
diabetes and osteoporosis are associated with
significant morbidity, decreased quality of life
and reduced life expectancy. In Australia, the
total number of adults with diabetes is projected
to rise to between 2 and 3 million by 2025
(Magliano et al, 2009). Osteoporosis is also
a condition that increases in prevalence with
ageing (Figure 2). Age-related bone loss and
Citation: Jahagirdar V, Gittoes NJ
(2016) Diabetes and bone health.
Diabetes & Primary Care Australia
2: 61–8
Article points
1. Diabetes and osteoporosis are
increasingly prevalent diseases.
2. Diabetes and its complications
influence important
determinants of bone strength
such as the material properties
of bone, bone density and
mineral content as well as
bone micro-architecture
and bone turnover.
3. Diabetes is an important
clinical risk factor for
osteoporosis and fracture,
and as clinicians it is
important to remember this
association when managing
people with diabetes.
Key words
– Bone
– Metabolic disorder
– Osteoporosis
Authors
Vidhya Jahagirdar is Specialty
Trainee Registrar in Diabetes,
Endocrinology and General
Internal Medicine; Neil Gittoes is
Consultant & Honorary Professor
of Endocrinology, Head, Centre
for Endocrinology, Diabetes and
Metabolism. Both are at the
Department of Endocrinology,
University Hospitals Birmingham
NHS Foundation Trust,
Birmingham, UK.
Diabetes & Primary Care Australia Vol 2 No 2 2017 61