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Osteoporos Int. 2018 Dec;29(12):2585-2596. doi: 10.1007/s00198-018-4650-2. Epub 2018 Jul 31.

Diagnosis and management of bone fragility in diabetes: an emerging challenge.

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Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland.
Department of Medicine, Holbaek Hospital, Holbaek, Denmark.
OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA.
Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden.
Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon.
Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.
Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada.
Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland.
Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan.
International Osteoporosis Foundation, Nyon, Switzerland.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.


Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.


Diabetes; Diabetes-related bone disease; Fracture; Osteoporosis

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