Critical review of bone health,fracture risk and management of bone fragility in diabetes mellitus  

作　　者：Rajan Palui Subhodip Pramanik Sunetra Mondal Sayantan Ray 

机构地区：[1]Department of Endocrinology,The Mission Hospital,Durgapur 713212,West Bengal,India [2]Department of Endocrinology,Neotia Getwel Healthcare Centre,Siliguri 734010,West Bengal,India [3]Department of Endocrinology,Institute of Post Graduate Medical Education and Research(IPGMER),Kolkata 700020,West Bengal,India [4]Department of Endocrinology,Medica Superspeciality Hospital and Medica Clinic,Kolkata 700099,West Bengal,India

出　　处：《World Journal of Diabetes》2021年第6期706-729,共24页世界糖尿病杂志（英文版）（电子版）

摘　　要：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 patho-physiology 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.

关 键 词：DIABETES Fracture risk Bone mineral density MICROARCHITECTURE Antidiabetic drugs Antiosteoporosis therapy 

分 类 号：R587.2[医药卫生—内分泌] R683[医药卫生—内科学]