Citation

Schwartz AV. Bone 2015; 82: 2-8.

Affiliation

Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16(th) Street Box 0560, San Francisco, CA 94143. Electronic address: aschwartz@psg.ucsf.edu.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.bone.2015.05.032

PMID

26027505

Abstract

Type 2 diabetes affects an increasing proportion of older adults, the population that is also at elevated risk of fracture. Type 2 diabetes itself increases the risk of fracture, particularly in African-American and Latino populations. In Western countries, overweight and obesity, associated with reduced fracture risk, are highly prevalent in diabetic patients. Studies in East Asian countries that have a lower prevalence of obesity with diabetes may help to disentangle the effects of diabetes and obesity on the skeleton. Type 2 diabetes is also associated with higher bone density, and as a result standard tools for fracture prediction tend to underestimate fracture risk in this population, an important challenge for risk assessment in the clinical setting. Contributing factors to the increased fracture risk in type 2 diabetes include more frequent falls and deficits in diabetic bone, not capture by dual x-ray absorptiometry (DXA), that are as yet not clearly understood. Recent epidemiological studies indicate that poor glycemic control contributes to increased fracture risk although intensive lowering of A1C is not effective in preventing fracture.

Language: en