Managing Bone Fragility in Older Adults with Diabetes: Pathophysiology, Assessment, and Therapeutic Considerations - PubMed
3 hours ago
- #osteoporosis
- #diabetes
- #bone fragility
- Older adults with diabetes (T1D and T2D) have a higher risk of fragility fractures, leading to increased morbidity and mortality.
- T1D is associated with reduced bone mineral density (BMD) due to insulinopenia, while T2D often has normal or high BMD but poor bone quality due to factors like microarchitecture changes and advanced glycation end products (AGEs).
- Standard fracture risk assessment tools like DXA and FRAX often underestimate risk, especially in T2D.
- Management includes optimizing glycemic control, lifestyle modifications (nutrition, exercise), and fall prevention strategies.
- Antidiabetic medications should be chosen carefully, avoiding those harmful to bone (e.g., thiazolidinediones) and preferring those with neutral or beneficial effects (e.g., metformin, DPP-4i, GLP-1 RAs).
- Osteoporosis treatments (bisphosphonates, denosumab, teriparatide, etc.) are effective in diabetes patients, though evidence is limited.
- Geriatric principles like assessing frailty and polypharmacy are crucial for optimal care.