Liu, Jian-Min; Zhu, Da-Long; Mu, Yi-Ming; Xia, Wei-Bo; Chinese Society of Osteoporosis and Bone Mineral Research, Chinese Society of Endocrinology and Chinese Diabetes Society, Chinese Medical Association
Patients with diabetes are at increased fracture risk, although their bone mineral densities (BMDs) in patients with diabetes are not always reduced. Furthermore, certain diabetes interventions have impact on bone. 35 experts from Chinese Society of Osteoporosis and Bone Mineral Research, Chinese Society of Endocrinology and Chinese Diabetes Society, Chinese Medical Association participated in formulating an expert consensus on the management of fracture risk in diabetes with several rounds of open meetings and discussions. Literature were searched through Pubmed, with references selected and synthesized according to the outline of the consensus. The consensus was drafted and finalized by one writing expert, was discussed, revised by the expert committee, and then reviewed and approved by the directors of the 3 societies. It was concluded that: Patients with diabetes have compromised bone quality and increased fracture risk. Those patients with high fracture risk should avoid thiazolidinediones (TZDs), and should use SGLT-2 inhibitor canagliflozin with particular caution. Bariatric surgery related bone loss should be evaluated and monitored. It is suggested to use Diabetes instead of Rheumatoid Arthritis in Fracture Risk Assessment Tool. DXA can still be recommended for BMD measurements to monitor BMDs changes in diabetes. Anti-osteoporotic therapies could be initiated when the T-score of BMD measured by DXA less than -2.5. The choice of anti-osteoporotic pharmaceutical intervention should be individualized, both anti-resorptive and bone anabolic agents could be used in patients with diabetes, and if sequential therapy is considered, one should begin with an anabolic agent, followed by an anti-resorptive drug. This article is protected by copyright. All rights reserved.