Diabetes mellitus (DM) and osteoporosis are the two important public health problems in India. The burden of both these conditions is expected to increase in the near future in view of changing lifestyle habits and ageing population. Indians are at risk of osteoporosis due to their low body mass index (BMI), genetic predisposition and nutritional factors. The diseases type 1 DM and type 2 DM (T2DM) are associated with increased fracture risk in the disease population, in spite of difference in the bone mineral density (BMD). An increase in fracture risk is also reported among older patients with T2DM despite frequently reported normal or increased BMD. Administration of insulin stimulates osteoblast activity and bone mineral apposition rates. The impact of endogenous insulin production, insulin sensitivity, and exogenous insulin administration as an anabolic agent for bone in T2DM has not been clarified. Biguanides and sulphonylureas do not appear to have adverse effects on BMD. Preclinical evidence suggests that incretin-based drugs may be beneficial for bone, but clinical evidence to support this hypothesis is not yet available. Thiazolidinedione (TZD) group of agents have been implicated in causing osteoporosis in various animal studies and some human studies available till date. The debate regarding this is issue is still ongoing. Randomized controlled studies with larger sample size preferably involving multiple centres, multiple ethnicities are required to answer these queries.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by swelling, tenderness, and destruction of synovial joints, leading to severe disability and premature mortality. The severity of inflammation is linked to an increased risk of cardiovascular mortality in the affected persons. Patients with RA are more prone for accelerated atherosclerosis than the general population. Atherosclerosis is in turn a risk factor for cardiovascular disease (CVD). Metabolic syndrome (MetS) is a major risk factor for the development of CVD. Evaluation of patients with RA for MetS appears to be clinically relevent because, not only are patients with RA more prone to develop atherosclerotic CVD, but when an associated MetS coexists this risk is further amplified. Investigations into the relationship between RA and the MetS have yielded conflicting results. While some studies reported a higher prevalence of MetS in patients with RA, others did not document such association. It has also been demonstrated that drugs which decrease rheumatoid inflammation are also useful in decreasing the MetS component of the disease.