Diabetes mellitus, bone mineral density, and fracture risk.
OBJECTIVE
To review recent research on type 1 and 2 diabetes mellitus, bone mineral density, and fractures and to identify high-priority research areas.


RESULTS
Recent meta-analyses and cohort studies confirm that type 1 and 2 diabetes are associated with higher fracture risk. These findings are not completely explained by lower bone mineral density in type 1 diabetes or the higher bone mineral density in type 2 diabetes. Studies provide new information on fracture risk for middle-aged diabetic adults, type 1 diabetic men, type 2 diabetic black women, and multiple sites. Recent case-control studies adjusted for key risk factors, and lower bone mineral density in type 1 diabetic adults remained significant at multiple sites. Prospective studies suggest an increased bone mineral density loss for type 2 diabetic white women and with thiazolidinedione use. Longitudinal cohort studies found that subclinical and clinical alterations in peripheral nerve, vascular, and kidney function were associated with lower bone mineral density, higher bone mineral density loss, or higher fracture rates in type 2 diabetic and nondiabetic older adults.


CONCLUSIONS
Prospective studies of risk factors for diabetic bone loss are needed. A greater elucidation of fracture etiology in diabetes has implications for preventive measures.
Strotmeyer
Elsa S
ES
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. strotmeyere@edc.pitt.edu
Cauley
Jane A
JA
D015519:Bone Density; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors