title: Skeletal Metabolism, Fracture Risk, and Fracture Outcomes in Type 1 and Type 2 Diabetes.
abstract: Fracture risk is significantly increased in both type 1 and type 2 diabetes, and individuals with diabetes experience worse fracture outcomes than normoglycemic individuals. Factors that increase fracture risk include lower bone mass in type 1 diabetes and compromised skeletal quality and strength despite preserved bone density in type 2 diabetes, as well as the effects of comorbidities such as diabetic macro- and microvascular complications. In this Perspective, we assess the developing scientific knowledge regarding the epidemiology and pathophysiology of skeletal fragility in patients with diabetes and the emerging data on the prediction, treatment, and outcomes of fractures in individuals with type 1 and type 2 diabetes.
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD dsellme1@jhmi.edu.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Sellmeyer
authors.affiliation: Division of Bone and Mineral Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Roberto
authors.initials: R
authors.lastname: Civitelli
authors.affiliation: Department of Medicine III and Center for Healthy Aging, Technische Universität Dresden, Germany and Center for Regenerative Therapies Dresden, Dresden, Germany.
authors.forename: Lorenz C
authors.initials: LC
authors.lastname: Hofbauer
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research and the Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Departments of Orthopaedic Surgery and Physiology and Pharmacology and Center for Diabetes and Endocrine Research, The University of Toledo College of Medicine and Life Sciences, Toledo, OH.
authors.forename: Beata
authors.initials: B
authors.lastname: Lecka-Czernik
authors.affiliation: Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
mesh_terms: D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D050723:Fractures, Bone / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D012307:Risk Factors