Diabetes and Osteoporotic Fractures

2005 ◽  
Vol 31 (2) ◽  
pp. 187-196 ◽  
Author(s):  
Karen Kemmis ◽  
Diana Stuber
Keyword(s):  
Treatment Options ◽  
Osteoporotic Fractures ◽  
Risk Of Fracture ◽  
Diabetes Educator ◽  
Appropriate Treatment ◽  
Increased Risk ◽  
Present Information ◽  
Patients With Diabetes

The purpose of this article is to present information that will assist the diabetes educator in screening patients with diabetes for risk of osteoporosis and fracture, to offer appropriate treatment options for patients, and to identify potential referrals to other providers for patients with diabetes and increased risk of fracture.

Comorbid Conditions and GFR Predict Nonvertebral Fractures in Patients With Diabetes in an Ethnic-Specific Manner

2020 ◽  
Vol 105 (6) ◽  
pp. e2168-e2175
Author(s):  
Rajesh K Jain ◽  
Mark G Weiner ◽  
Huaqing Zhao ◽  
Tamara Vokes
Keyword(s):  
Risk Factors ◽  
Osteoporotic Fractures ◽  
Comorbid Conditions ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Major Osteoporotic Fractures ◽  
Specific Manner ◽  
Patients With Diabetes ◽  
Race Ethnicity ◽  
Insulin Use

Abstract Context Diabetes mellitus (DM) is associated with an increased risk of fracture, but it is not clear which diabetes and nondiabetes risk factors may be most important. Objective The aim of the study was to evaluate risk factors for incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African American (AA), Hispanic (HIS), and Caucasian (CA) subjects with DM. Methods This was a retrospective cohort study of 18 210 subjects with DM (7298 CA, 7009 AA and 3903 HIS) at least 40 years of age, being followed at a large healthcare system in Philadelphia, Pennsylvania. Results In a global model in CA with DM, MOF were associated with dementia (HR 4.16; 95% CI, 2.13-8.12), OSA (HR 3.35; 95% CI, 1.78-6.29), COPD (HR 2.43; 95% CI, 1.51-3.92), and diabetic neuropathy (HR 2.52; 95% CI, 1.41-4.50). In AA, MOF were associated with prior MOF (HR 13.67; 95% CI, 5.48-34.1), dementia (HR 3.10; 95% CI, 1.07-8.98), glomerular filtration rate (GFR) less than 45 (HR 2.05; 95% CI, 1.11-3.79), thiazide use (HR 0.54; 95% CI, 0.31-0.93), metformin use (HR 0.59; 95% CI, 0.36-0.97), and chronic steroid use (HR 5.03; 95% CI, 1.51-16.7). In HIS, liver disease (HR 3.06; 95% CI, 1.38-6.79) and insulin use (HR 2.93; 95% CI, 1.76-4.87) were associated with MOF. Conclusion In patients with diabetes, the risk of fracture is related to both diabetes-specific variables and comorbid conditions, but these relationships vary by race/ethnicity.

scholarly journals Obesity and Bone: A Complex Relationship

2021 ◽  
Vol 22 (24) ◽  
pp. 13662
Author(s):  
Giuseppe Rinonapoli ◽  
Valerio Pace ◽  
Carmelinda Ruggiero ◽  
Paolo Ceccarini ◽  
Michele Bisaccia ◽  
...  
Keyword(s):  
High Fat Diet ◽  
Obese Subject ◽  
Osteoporotic Fractures ◽  
Mechanical Effect ◽  
Normal Weight ◽  
Obese Children ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Risk Of Falls ◽  
The Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

scholarly journals Effect of Antidiabetic Treatment on Bone

2019 ◽  
pp. S107-S120 ◽  
Author(s):  
J. JACKULIAK ◽  
M. KUŽMA ◽  
J. PAYER
Keyword(s):  
Diabetes Mellitus ◽  
Bone Fractures ◽  
Negative Impact ◽  
Osteoporotic Fractures ◽  
Antidiabetic Drugs ◽  
Mineral Density ◽  
Skeletal Health ◽  
Antidiabetic Treatment ◽  
Increased Risk ◽  
Patients With Diabetes

Patients with diabetes mellitus are at an increased risk of bone fractures. Several groups of effective antidiabetic drugs are available, which are very often given in combination. The effects of these medications on bone metabolism and fracture risk must not be neglected. Commonly used antidiabetic drugs might have a positive, neutral or negative impact on skeletal health. Increased risk of fracture has been identified with use of thiazolidinediones, most definitively in women. Also treatment with sulfonylureas can have adverse effects on bone. One consequence of these findings has been greater attention to fracture outcomes in trails of new diabetes medication (incretins and SGLT-2 inhibitors). The effect of insulin on bone is discussed and the risk of fractures in patients using insulin seems to be unrelated to insulin as itself. The aim of the review is to summarize effects of antidiabetic treatment on bone – bone mineral density, fractures and bone turnover markers. The authors also try to recommend a strategy how to treat patients with diabetes mellitus regarding the risk of osteoporotic fractures. In this review the problem of how to treat osteoporosis in patient with diabetes is also discussed.

scholarly journals Increased Risk of Fracture and Postfracture Adverse Events in Patients With Diabetes: Two Nationwide Population-Based Retrospective Cohort Studies

Diabetes Care ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. 2246-2252 ◽  
Author(s):  
Chien-Chang Liao ◽  
Chao-Shun Lin ◽  
Chun-Chuan Shih ◽  
Chun-Chieh Yeh ◽  
Yi-Cheng Chang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cohort Studies ◽  
Retrospective Cohort ◽  
Population Based ◽  
Risk Of Fracture ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Retrospective Cohort Studies

scholarly journals Treatment Options for Patients with Type 2 Diabetes Mellitus during the Fasting Month of Ramadan

2020 ◽  
Vol 49 (7) ◽  
pp. 468-476
Author(s):  
Huai Heng Loh ◽  
Nor Azmi Kamaruddin
Keyword(s):  
Type 2 Diabetes ◽  
Review Paper ◽  
Treatment Options ◽  
Sglt2 Inhibitor ◽  
Limited Data ◽  
Ramadan Fasting ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Medication Dose

During Ramadan, Muslims fast from sunrise (Sahur) to sunset (Iftar) and are required to abstain from food and fluids, including oral and injectable medications. Patients with diabetes who fast during Ramadan are at risk of developing hyperglycemia with increased risk of ketoacidosis, hypoglycemia, dehydration and thrombosis. Pre-Ramadan education and preparation of a fasting patient are essential to reduce severe complications. This review paper summarizes studies to date on oral and injectable medications available for patients with type 2 diabetes during Ramadan fasting, as well as recommendations on management of these patients during Ramadan. Although there is limited data on the use of Metformin, Acarbose and Thiazolidinedione in Ramadan, they appear to be safe. Sulphonylurea, especially Glibenclamide, is associated with higher risk of hypoglycemia during Ramadan fasting, hence may need adjustment in dosing and timing. The incretin group and SGLT2 inhibitor use during Ramadan fasting is associated with low risk of hypoglycemia with no increased adverse events. Insulin regimes need to be individualized for patients who fast during Ramadan. Key words: Anti-diabetic medication dose adjustment; Iftar (sunset), Muslims; Sahur (sunrise); Treatment modification

scholarly journals Features of bone metabolism in diabetes mellitus

2018 ◽  
Vol 20 (3) ◽  
pp. 82-89 ◽  
Author(s):  
Guzel M. Nurullina ◽  
Guzyal I. Akhmadullina
Keyword(s):  
Diabetes Mellitus ◽  
Bone Formation ◽  
Bone Metabolism ◽  
Bone Remodeling ◽  
Osteoporotic Fractures ◽  
Bone Fragility ◽  
Obesity And Diabetes ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Low Bone Turnover

Patients with diabetes mellitus (DM) have an increased risk of osteoporotic fractures, which is associated with a bone fragility. Accumulation of advanced glycation end products, hyperhomocysteinemia causes increased apoptosis of osteocytes, decreased bone formation and bone remodeling in DM. Adiponectin stimulates osteocalcin expression and osteoblast differentiation through the activation of AMPK. AMPK-activation stimulates differentiation and mineralization of osteoblasts. Hypoadiponectinemia, which is often observed in obesity and diabetes, can causes bone fragility. Diabetes mellitus is a state of low bone turnover, which is confirmed by decreased markers of bone formation (osteocalcin, P1NP), decreased markers of bone resorption (CTX, TRAP), increased regulatory markers of bone remodeling (OPG, sclerostin). Thus, the study of the pathophysiology of bone metabolism, the level of bone metabolism markers in patients with diabetes mellitus gives broad prospects in understanding the mechanisms of osteoporosis as complication of diabetes mellitus, the selection of targeted therapy and the improvement of early diagnosis of the disease.

scholarly journals PROFILE OF OSTEOPOROTIC FRACTURES

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Gopal Yadav ◽  
Chetan Laljibhai Rathod
Keyword(s):  
Vitamin D ◽  
Lumbar Spine ◽  
Distal Radius ◽  
Proximal Femur ◽  
Proximal Humerus ◽  
Osteoporotic Fractures ◽  
High Energy ◽  
World Health ◽  
Risk Of Fracture ◽  
Increased Risk

Introduction: Osteoporosis is a widespread global disorder characterized by decreased bone mass and altered bone architecture, resulting in increased fragility of the bone and an increased risk of fracture. The prevalence of osteoporosis is projected to rise dramatically in the future due to ageing of population. Leading to increased risk of fracture, osteoporosis is defined as a disorder of skeleton which is characterized by weak strength of bones according to National Institutes of Health Consensus Development Panel. According to the criteria laid by World Health Organization (WHO). There are various causes of osteoporosis which includes growing older with age, rheumatoid arthritis, lower body mass index, gender, premature ovarian failure, deficiency of vitamin D, alchohol abuse, poor consumption of calcium, medications. Osteoporosis sometimes may not be diagnosed until occurrence of fracture since it is a silent disease. Material and Methods: The study group which comprised of cases was subjects with osteoporotic fractures above 45 years of age having any one or combination of fractions mentioned below: Thoraco-lumbar spine, distal radius, proximal femur, proximal humerus, mechanism of low-energy trauma. Patients with high-energy trauma or fractures, road side accidents and/or below 45 years of age were not included in this study. The control group comprised of subjects above 45 years of age suffering from osteoarthritis. Results: Majority of females were observed in cases as well as controls in present studies with number of females in cases being  21 in cases while 18 in controls among 30 subjects belonging to each group. It is observed that among all fractures in cases which were included in present study, majority of fractures were proximal femur which accounted for 43% of total fractures followed by distal radius 30%, proximal humerus 20% and thoraco-lumbar spine 7%. Conclusion: Compromised by strength of bone leading to an increased fracture risk, osteoporosis is a skeletal disorder. Older patients, females, patients with higher BMI and weighed more had a greater proportion of osteoporotic fractures. Keywords: osteoporotic fractures, BMI, Vitamin D, alchohol abuse, calcium.

Managing Cardiovascular Risk in Patients with Type 2 Diabetes – Challenges and Opportunities

2010 ◽  
Vol 6 (4) ◽  
pp. 31
Author(s):  
Lars Rydén ◽  
Linda Mellbin ◽  
Klas Malmberg ◽  
◽  
◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Clinical Trial Data ◽  
Oral Glucose ◽  
Lifestyle Modifications ◽  
Oral Glucose Tolerance Testing ◽  
Coronary Death ◽  
Increased Risk ◽  
Challenges And Opportunities ◽  
Patients With Diabetes ◽  
Multifactorial Approach

The prevalence of diabetes and its associated complications, such as cardiovascular disease (CVD), has increased over recent years and is expected to continue to rise dramatically. People with diabetes have a poor prognosis, with a substantially increased risk of coronary heart disease, coronary death, non-fatal myocardial infarction, stroke, and other vascular deaths compared with non-diabetic subjects. Conversely, studies have also shown that many patients with CVD have undiagnosed dysglycaemia and that already impaired glucose tolerance and newly detected diabetes are associated with an impaired prognosis. Thus, screening for such conditions, preferably with oral glucose tolerance testing, should be performed in all patients with CVD. Guidelines advocate a multifactorial approach to the management of prediabetes, diabetes and CVD. This includes lifestyle modifications as well as targets for glycaemic control, blood pressure, lipids, and other cardiometabolic risk factors. Although clinical trial data have demonstrated that target-driven strategies can improve outcomes in patients with diabetes, the implementation and execution of these regimens in clinical practice needs to improve.

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