Osteoporosis and type 2 diabetes

Fractures are common in the elderly, have a detrimental effect on the quality of life and are associated with increased mortality. Patients with type 2 diabetes have a further moderately elevated risk of fractures although they show a comparable or even increased bone mineral density. This is clinically relevant due to the widespread occurrence of type 2 diabetes. Possible causes and mechanisms of the elevated risk of fractures in diabetics are discussed and advice for clinical management is given taking the higher fracture risk in this population into account. This article is based on the currently available review articles on type 2 diabetes and bone health. Furthermore, the most relevant original articles on this topic are cited. Increased falls related to diabetic complications, longer disease duration and lack of glucose control are associated with a higher fracture risk in patients with type 2 diabetes. Even though the bone density is normal, a higher cortical porosity and alterations in collagen structure reduce bone quality. Some oral antidiabetic agents have detrimental effects on bone metabolism. General recommendations for optimal calcium and vitamin D intake in patients without diabetes are also appropriate in this population. Evidence regarding a possible altered effectiveness of pharmacological treatment of osteoporosis in diabetics is limited. According to post hoc analyses this does not appear to be the case; however, treatment of osteoporosis in patients with type 2 diabetes follows the current guidelines for non-diabetic postmenopausal women and men with osteoporosis.