People with both types of diabetes could be at higher risk of bone fractures, according to an expert review conducted by the International Osteoporosis Foundation (IOF).
The risk of hip fractures in type 1 diabetes is of particular concern as it is approximately 6.5 times higher than in the general population, when looking at a mean age of 65. The risk is 2.5-fold higher for people with type 1 diabetes than in type 2 diabetes.
The review, which was published in the Nature Reviews Endocrinology journal, suggested that diabetes can affect the health of bones.
Reasons for the bone fragility risk include several factors including hyperglycemia and the longer the person has the disease, the higher the risk of suffering from bone health complications.
Professor Serge Ferrari, chair of the IOF Bone and Diabetes Working Group and Professor at the Geneva University Hospital, Switzerland said: “Currently, no guidelines exist on how and at which stage of the disease to initiate anti-osteoporotic medication in patients with diabetes mellitus.
In terms of type 2 diabetes medications, Prof. Ferrari stated: “Medications with a neutral or favourable effect on bone metabolism, such as metformin and incretin-based treatments, are preferable. In contrast medications like TZDs should be used with caution.”
TZDs is the shortened name for thiazolidinediones, the class of type 2 diabetes drugs that includes Actos (pioglitazone).
Professor Massimo Massi Benedetti, senior programmes advisor from the International Diabetes Federation (IDF) and member of the IOF Working Group, said: “It is important that health professionals are aware that fragility fractures are a severe complication of diabetes.
“Prevention strategies in the treatment of diabetes are to be implemented from the early stage of the disease, while the risk of fractures needs to be evaluated on a routine basis in the population at risk in order to minimise the effect of the clinical factors that have been identified as the possible cause of higher frequency of bone fractures in diabetes.
“With increasing clinical awareness, ongoing research and the development of specific new drugs we are hoping that there will be new opportunities to improve bone health in people with diabetes in the future.”

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