Osteoporosis and diabetes - possible links and diagnostic difficulties.

IF 1.4 Q3 RHEUMATOLOGY
Reumatologia Pub Date : 2023-01-01 Epub Date: 2023-09-03 DOI:10.5114/reum/170048
Joanna Magdalena Tomasiuk, Anna Nowakowska-Płaza, Małgorzata Wisłowska, Piotr Głuszko
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引用次数: 0

Abstract

Objectives: In this review, the authors aimed to clarify the relationship between the occurrence of osteoporosis and diabetes, analyze the differences between the pathogenesis of osteoporosis in different types of diabetes and propose the most effective diagnostic strategy and fracture risk assessment in diabetic patients.

Material and methods: A analysis of publications in MEDLINE, COCHRANE and SCOPUS databases was performed, searching for reports on the diagnostics, fracture risk assessment, prevention, and treatment of osteoporosis in patients with diabetes mellitus (DM) published in the years 2016-2022. The key words for the search were: diabetes, osteoporosis, and low-energy fracture.

Results: Bone complications of T1DM are more severe than T2DM, because of the lack of anabolic effect of insulin on bones. In T2DM the risk of fractures is elevated; however, identifying the mechanisms underlying the increased risk of fractures in T2DM is not clear. The FRAX tool is not appropriate for assessing the fracture risk in young patients with T1DM. It is quite useful in older patients with T2DM, but in these patients the calculated fracture risk may be underestimated. In T2DM the fracture risk often does not correspond to BMD value as measured by dual-energy X-ray absorptiometry (DXA). Diagnostic tools such as the trabecular bone score may play a significant role in this group of patients. Conclusions: Optimal strategies to identify and treat high risk individuals require further research and proper definition. The diagnostic criteria for osteoporosis should be clearly defined as well as fracture risk assessment and choice of anti-osteoporotic medication. In all cases of secondary osteoporosis, treatment of the underlying disease is the most important. The relationship between high risk of fractures and diabetes is inseparable, and its full understanding seems to be the key to effective management.

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骨质疏松症和糖尿病——可能的联系和诊断困难。
目的:在这篇综述中,作者旨在阐明骨质疏松症的发生与糖尿病之间的关系,分析不同类型糖尿病骨质疏松症发病机制的差异,并提出糖尿病患者最有效的诊断策略和骨折风险评估。材料和方法:对MEDLINE、COCHRANE和SCOPUS数据库中的出版物进行分析,检索2016-2022年发表的糖尿病(DM)患者骨质疏松症的诊断、骨折风险评估、预防和治疗报告。搜索的关键词是:糖尿病、骨质疏松症和低能量骨折。结果:T1DM的骨并发症比T2DM更严重,因为胰岛素对骨缺乏合成代谢作用。在T2DM中,骨折的风险升高;然而,确定T2DM骨折风险增加的潜在机制尚不清楚。FRAX工具不适用于评估年轻T1DM患者的骨折风险。它在老年T2DM患者中非常有用,但在这些患者中,计算的骨折风险可能被低估。在T2DM中,骨折风险通常与双能X射线吸收仪(DXA)测量的BMD值不一致。骨小梁评分等诊断工具可能在这组患者中发挥重要作用。结论:识别和治疗高危个体的最佳策略需要进一步研究和正确定义。骨质疏松症的诊断标准应明确,骨折风险评估和抗骨质疏松药物的选择也应明确。在所有继发性骨质疏松症的病例中,对潜在疾病的治疗是最重要的。骨折高风险与糖尿病之间的关系是不可分割的,充分认识它似乎是有效管理的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reumatologia
Reumatologia Medicine-Rheumatology
CiteScore
2.70
自引率
0.00%
发文量
44
审稿时长
10 weeks
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