Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2019)

Muschitz, Christian; Kautzky‐Willer, Alexandra; Rauner, Martina; Winhofer-Stöckl, Yvonne; Haschka, Judith

doi:10.1007/s00508-019-1462-0

Cited by 6 publications

(8 citation statements)

References 49 publications

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“…A subsequent retrospective study in a Canadian cohort (82,094 diabetic adults and 236,682 controls) showed that in subjects with T2D for more than 5 years, there was an increased risk of both fracture at all osteoporotic sites (1.15–95% CIs, 1.09–1.22) and hip fractures (1.4–95% CIs, 1.28–1.53) as compared to T2D patients with a shorter duration of disease [ 135 ]. Based on these data and on other similar observations, a T2D duration of 5 [ 131 , 132 ] or 10 years [ 2 ] was suggested in the position statements. In this respect, however, it should be remarked that T2D often remains a misdiagnosed disease for several years.…”

Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 72%

“…In fact, the measurement of BMD or the use of algorithms such as FRAX often underestimates fracture risk in patients with T2D [ 15 , 16 ]. Thus, the presence of a previous fragility fracture, together with specific risk factors associated with increased fracture risk in T2D, represents the initial information to be considered for the stratification of fracture risk in these patients, as recently outlined by some position statements [ 2 , 131 , 132 ]. A representative flowchart summarizing the outcomes from one of these documents [ 2 ] that is also, in part, consistent with a previous report from a working group from the International Osteoporosis Foundation [ 131 ] is shown in Figure 3 .…”

Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 99%

“…Furthermore, poor glycemic control can result in an elevated risk of fracture, regardless of the duration of the disease, as also evidenced by the Rotterdam Study, in which, within a sample of 4.135 diabetic subjects with an average follow-up of 12.2 years, a 1.6-fold increased risk of fracture was shown in individuals with poorly controlled diabetes compared to those with good glycemic control [ 138 ]. Given the relative contribution of a single measurement of fasting glucose or HbA1c levels as a risk factor for bone fragility in T2D (since persistent rather than transient hyperglycemia is considered to be a relevant condition that negatively affects bone health), it has been suggested that only those cases with persistently impaired glucose control (e.g., HbA1c levels above 7.5–8% for at least 1 year), irrespective of T2D duration, or the presence of complications, should be also be considered at risk of fracture [ 2 , 131 , 132 ]. Finally, some antidiabetic drugs such as thiazolidinediones or insulin have been related to an increased risk of fractures in diabetes and should be thus considered as additional risk factors [ 2 , 131 , 132 ].…”

Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 99%

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Role of Advanced Glycation End-Products and Oxidative Stress in Type-2-Diabetes-Induced Bone Fragility and Implications on Fracture Risk Stratification

et al. 2023

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Type 2 diabetes (T2D) and osteoporosis (OP) are major causes of morbidity and mortality that have arelevant health and economic burden. Recent epidemiological evidence suggests that both of these disorders are often associated with each other and that T2D patients have an increased risk of fracture, making bone an additional target of diabetes. As occurs for other diabetic complications, the increased accumulation of advanced glycation end-products (AGEs) and oxidative stress represent the major mechanisms explaining bone fragility in T2D. Both of these conditions directly and indirectly (through the promotion of microvascular complications) impair the structural ductility of bone and negatively affect bone turnover, leading to impaired bone quality, rather than decreased bone density. This makes diabetes-induced bone fragility remarkably different from other forms of OP and represents a major challenge for fracture risk stratification, since either the measurement of BMD or the use of common diagnostic algorithms for OP have a poor predictive value. We review and discuss the role of AGEs and oxidative stress on the pathophysiology of bone fragility in T2D, providing some indications on how to improve fracture risk prediction in T2D patients.

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Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 72%

Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 99%

Section: Assessment Of Fracture Risk In Patients With Type 2 Diabetesmentioning

confidence: 99%

See 1 more Smart Citation

Role of Advanced Glycation End-Products and Oxidative Stress in Type-2-Diabetes-Induced Bone Fragility and Implications on Fracture Risk Stratification

et al. 2023

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“…However, as IA prevent peripheral estrogen production, they suppress circulating estrogen levels, causing accelerated bone loss and an increased risk of fractures (YAO et al, 2020). Furthermore, DM2 is another one of the many chronic conditions associated with the development of osteoporosis (MUSCHITZ et al, 2019). In this context, patients at increased risk of bone loss should undergo bone densitometry (BMD) within 3 months after AI therapy accompanied by supplementation and preventive therapy to prevent bone loss (OTTANELLI, 2015).…”

Section: Resultsmentioning

confidence: 99%

Pharmacotherapeutic Follow-Up of a Patient With Multimorbities: Experience Report

Aguiar¹,

Alencar²,

Rodrigues³

et al. 2023

Arq. Ciênc. Saúde Unipar

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Chronic non-communicable diseases are growing global health problems. The objective of this study was to promote pharmaceutical care for a patient with multimorbidities in order to improve its quality of life. A pharmacotherapeutic follow-up was performed using the SOAP method, registered in the form of clinical evolution, along with laboratory tests, anthropometric measurements and application of validated instruments to assess pharmacological adherence, mental health and quality of life. The report deals with a female patient, 55 years old, obese and dyslipidemic, sedentary, hypertensive, diabetic and on the control phase of breast cancer. Self-medication with antibiotics and a proton pump inhibitor was identified. Despite the good pharmacological adherence, the patient had decompensated diabetes, accompanied by dyslipidemia without treatment and interruption of supplements. After pharmacological and non-pharmacological interventions, the patient showed a significant improvement in the reduction of anthropometric measurements and in biochemical parameters. At the end of the follow-up, pharmaceutical care proved to be fundamental in identifying the patient's health problems, contributing to obtain a more rational pharmacotherapy.

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“…According to the International Osteoporosis Foundation (IOF), diabetes and bone workout group, T-score ≤ -2 and not -2.5 is a strong indication of osteoporosis treatment administration [40]. DEXA should be accompanied by TBS measurement while the FRAX score should be adjusted for T2DM [40][41]. This should be done by clicking the choice of secondary osteoporosis in the FRAX tool.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review: Are the Elderly With Diabetes Mellitus Type 2 Prone to Fragility Fractures?

Papaioannou¹,

Πανταζίδου²,

Kokkalis³

et al. 2021

Cureus

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Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence rates among older adults while fragility fractures constitute a significant public health burden with a great impact. Osteoporosis is the most important metabolic bone disease in patients with diabetes mellitus. Based on current evidence, individuals with T2DM are more vulnerable to fragility fractures than their non-diabetic counterparts, although until now, there aren't any systematic reviews or meta-analyses concerning the impact of T2DM on the risk of fragility fractures in elderly patients. The aim of this study is to fill this gap in the current literature concerning this specific patient group.Literature in PubMed and Google Scholar was searched for relevant articles published up to January 2021. The keywords used were: elderly, diabetes mellitus type 2, and fragility fractures. Among the 180 articles retrieved, only four full-text articles were eligible and, finally, two studies (one population-based cohort study and one cross-sectional study) met the inclusion criteria for the review. Although we identified 15 records through the manual research, finally 17 records were included in the current review. The records retrieved from the manual research were 11 prospective cohort studies, two population-based studies, one prospective observational study, and one retrospective cohort study. The author's name, year of publication, country, type of study, and number of patients were reported.According to this systematic review, there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM while there is relative controversy concerning non-vertebral fractures. Vertebral fractures in the elderly with T2DM require further evaluation because the results from cohort studies are more conflicting. Finally, insulin usage can increase the possibility of fragility fractures and can even double this risk. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients, due to several additional aggravating factors such as senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, and the presence of diabetes-related complications (mainly neuropathy and retinopathy). Clinicians who treat these patients should be aware of the special diagnostic and therapeutic approaches concerning these patients.

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Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2019)

Cited by 6 publications

References 49 publications

Role of Advanced Glycation End-Products and Oxidative Stress in Type-2-Diabetes-Induced Bone Fragility and Implications on Fracture Risk Stratification

Role of Advanced Glycation End-Products and Oxidative Stress in Type-2-Diabetes-Induced Bone Fragility and Implications on Fracture Risk Stratification

Pharmacotherapeutic Follow-Up of a Patient With Multimorbities: Experience Report

Systematic Review: Are the Elderly With Diabetes Mellitus Type 2 Prone to Fragility Fractures?

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