Calcium2026-05

[Diagnosis and management of diabetes and co-existing osteoporosis (Update 2026)].

Muschitz Christian, Kautzky-Willer Alexandra, Rauner Martina, Winhöfer-Stöckl Yvonne et al. — Wiener klinische Wochenschrift

Summary

This paper discusses how diabetes can increase the risk of bone fractures and provides updated guidance for managing both conditions together. It emphasizes that people with diabetes who are at risk of fractures should receive similar bone health treatment as others, including ensuring adequate calcium and vitamin D intake, ideally through diet.

AI-generated summary — read the original

Key points

Diabetes can increase an individual's risk of experiencing bone fractures.
Bone health management for people with diabetes and fracture risk should be similar to those without diabetes.
Ensuring sufficient intake of calcium and vitamin D is crucial for maintaining bone health in these patients.
When selecting diabetes medications, it's important to consider their potential effects on bones.

What the study looked at

What question did this paper address? This paper aimed to provide updated guidance on how to diagnose and manage osteoporosis, a condition causing weak bones, in individuals who also have diabetes. It specifically focused on the increased risk of bone fractures observed in people with diabetes. How was the information gathered? This publication is a comprehensive update, synthesizing existing scientific evidence and clinical recommendations. It reviews the current understanding of how diabetes affects bone health and outlines best practices for healthcare providers in managing both conditions together. It doesn't describe a new study with participants but rather consolidates established knowledge. What did the paper find? The paper highlights that people with diabetes face a higher risk of fragility fractures. It recommends that the approach to managing bone health in diabetic patients at risk of fractures should generally mirror that for non-diabetic individuals, emphasizing sufficient calcium and vitamin D intake, ideally from food. It also suggests considering the bone effects of diabetes medications.

Dietary takeaway

For individuals with diabetes, paying attention to bone health is especially important due to an increased risk of fractures. Ensuring you get enough calcium and vitamin D through your diet, from sources like dairy products, fortified plant milks, leafy greens, and fatty fish, is a key step. Remember, this paper is a guideline update, and while valuable, individual dietary needs should always be discussed with a healthcare professional.

Abstract

Diabetes mellitus and osteoporosis are among the most frequent chronic diseases and therefore often occur in one and the same individual. As the prevalence of both diseases increases with age, in view of the age structure of our population their frequency will increase. Patients with diabetes have an elevated risk of fragility fractures. The pathophysiology is unclear and presumably multifactorial. Longitudinal studies have shown that the Fracture Risk Assessment Tool (FRAX) and the bone mineral density (BMD) measured by dual energy X‑ray absorptiometry (DXA, T‑score) and a possibly present trabecular bone score (TBS) can predict the individual risk of fractures; however, an adjustment must be made in order not to underestimate the risk. From an osteological perspective an optimal approach is not yet available as there are no studies with patients who have only diabetes and osteoporosis. Patients with diabetes mellitus and an elevated risk of fractures should be treated in exactly the same way as patients with an increased risk of fractures but without diabetes. The vitamin D level should in every case always be optimized and a sufficient calcium intake should be ensured (preferably via the nutrition). In the selection of the antihyperglycemic treatment, substances with a proven negative effect on bones should be omitted. In the case of a fragility fracture a long-term specific osteological treatment is indicated, independent of all available findings. Antiresorptive medications are the first choice for prevention of fragility fractures and also anabolic drugs according to national reimbursement criteria. Monitoring of treatment should be carried out in compliance with the national osteoporosis guidelines (revised version Autumn 2024).

View on PubMed →DOI: 10.1007/s00508-025-02664-x