Bone health in diabetes: Indian perspective

Abstract

Purpose of review Despite estimated 77 million people having diabetes, bone health in Asian Indians with diabetes is largely unknown. This review summarizes the published literature on fracture risk and factors affecting it in Asian Indians with diabetes. Recent findings Data on fracture prevalence in diabetes is limited; one study showed that diabetes was associated with a significantly higher number of fractures compared with subjects without diabetes (4% vs. 2.4%, P < 0.05). The prevalence of osteoporosis in Asian Indians with type 2 diabetes mellitus (T2D) varies from 35.5 to 49.5%. Studies have shown an increased, similar or lower areal bone mineral density (BMD) at the lumbar spine and/or hip in patients with T2D compared to controls without diabetes. On the contrary, the BMD in patients with type 1 diabetes mellitus (T1D) is modestly low compared to age- and sex-matched healthy controls without diabetes. Recent studies have shown compromised mechanical, material and compositional properties of trabecular bone in Asian Indians with T2D suggesting deteriorated bone quality as one of the contributors of high fracture risk. Summary Further research is needed to generate evidence-based guidelines to prevent and manage bone fragility in Asian Indians with diabetes.

Efficacy of zoledronate, denosumab or teriparatide in postmenopausal women with type 2 diabetes mellitus at high risk of fragility fractures: protocol of an open, blinded endpoint randomized controlled pilot trial

“…The apparent paradox between increased BMD and high fracture risk is explained by deteriorated bone microarchitecture. 1 , 5 The Framingham HR-pQCT study reported that people with T2D had lower cortical vBMD, higher cortical porosity and smaller cross-sectional area only at the tibia. Trabecular indices were similar or more favourable in T2D than in non-T2D.…”

“…Several epidemiological studies have consistently shown that people with diabetes are at a high risk of fragility fractures than non-diabetic controls. 1 The risk is increased in type 1 (T1D) as well as type 2 diabetes (T2D), being consistently higher in people with T1D than in T2D. In a recent meta-analysis that included more than 17 million people with diabetes, the relative risk of hip and non-vertebral fractures in people with T2D was 1.33 and 1.19, respectively.…”