Palui R, Pramanik S, Mondal S, Ray S. Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus. World J Diabetes 2021; 12(6): 706-729 [PMID: 34168723 DOI: 10.4239/wjd.v12.i6.706]
Corresponding Author of This Article
Sayantan Ray, MBBS, MD, Department of Endocrinology, Medica Superspeciality Hospital and Medica Clinic, 127, EM Bypass, Mukundapur, Kolkata 700099, West Bengal, India. sayantan.ray30@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Jun 15, 2021; 12(6): 706-729 Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.706
Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus
Rajan Palui, Subhodip Pramanik, Sunetra Mondal, Sayantan Ray
Rajan Palui, Department of Endocrinology, The Mission Hospital, Durgapur 713212, West Bengal, India
Subhodip Pramanik, Department of Endocrinology, Neotia Getwel Healthcare Centre, Siliguri 734010, West Bengal, India
Sunetra Mondal, Department of Endocrinology, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata 700020, West Bengal, India
Sayantan Ray, Department of Endocrinology, Medica Superspeciality Hospital and Medica Clinic, Kolkata 700099, West Bengal, India
Sayantan Ray, Department of Endocrinology, Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata 700137, West Bengal, India
Author contributions: Palui R performed the literature search, wrote the first draft and provided intellectual input; Pramanik S and Mondal S conceptualized the work, performed a literature search, supervised the writing, provided intellectual input and critically revised the manuscript; Ray S supervised the literature search and the writing, provided intellectual input and critically revised the manuscript.
Conflict-of-interest statement: Nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sayantan Ray, MBBS, MD, Department of Endocrinology, Medica Superspeciality Hospital and Medica Clinic, 127, EM Bypass, Mukundapur, Kolkata 700099, West Bengal, India. sayantan.ray30@gmail.com
Received: January 27, 2021 Peer-review started: January 27, 2021 First decision: March 30, 2021 Revised: April 8, 2021 Accepted: April 29, 2021 Article in press: April 29, 2021 Published online: June 15, 2021
Abstract
The risk of fracture is increased in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, in contrast to the former, patients with T2DM usually possess higher bone mineral density. Thus, there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes. Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk. Moreover, some antidiabetic medications further enhance the fragility of the bone. On the other hand, antiosteoporosis medications can affect the glucose homeostasis in these patients. It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk. Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature. With the advancement in imaging technology, newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes. The purpose of this review is to explore the pathophysiology behind poor bone health in diabetic patients. Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.
Core Tip: Diabetes mellitus, either type 1 or type 2, has adverse effects on bone that translate into an elevated fracture risk. Different pathophysiological mechanisms contribute to poor bone health in patients with diabetes. Diagnosis of bone fragility in diabetic patients is challenging as traditional fracture predictors underestimate fracture risk in this population, contributing to the concept that diabetes affects bone quality. While waiting for further evidence, the prevention and management of bone fragility in diabetes should include identification of patients at risk, correction of modifiable risk factors, appropriate choice of antidiabetic medications and use of antiosteoporosis drugs with proven efficacy.
