TY - JOUR
T1 - Management of bone fragility in type 2 diabetes
T2 - Perspective from an interdisciplinary expert panel
AU - Chiodini, Iacopo
AU - Gaudio, Agostino
AU - Palermo, Andrea
AU - Napoli, Nicola
AU - Vescini, Fabio
AU - Falchetti, Alberto
AU - Merlotti, Daniela
AU - Eller-Vainicher, Cristina
AU - Carnevale, Vincenzo
AU - Scillitani, Alfredo
AU - Pugliese, Giuseppe
AU - Rendina, Domenico
AU - Salcuni, Antonio
AU - Bertoldo, Francesco
AU - Gonnelli, Stefano
AU - Nuti, Ranuccio
AU - Toscano, Vincenzo
AU - Triggiani, Vincenzo
AU - Cenci, Simone
AU - Gennari, Luigi
N1 - Funding Information:
I Chiodini received consultancy fees from HRA Pharma and Corcept Therapeutics. A Gaudio received consultancy fees from Merck and UCB Pharma. A Palermo received consultancy fees from Amgen and Abiogen Pharma. N Napoli received consultancy fees from Eli Lilly, UCB Pharma and Abiogen Pharma. F Vescini received grants from Gilead Sciences LTD and Abiogen Pharma. A Falchetti received consultancy fees from Abiogen Pharma. DM received consultancy fees from Itapharma and UCB Pharma. C Eller-Vainicher received grants from Fondazione Eli-Lilly , and consultancy fees from Kyowa-Kirin and Amgen. G Pugliese received consultancy fees from Astra-Zeneca, Eli Lilly, Sigma-tau, and Takeda. F Bertoldo received grants from Abiogen Pharma , Amgen, and Eli Lilly and consultancies from Jansen and UCB Pharma. S Gonnelli received consultancy fees from Eli Lilly, Sandoz, Italfarmaco, and Abiogen Pharma. R Nuti received consultancy fees from Sandoz, Pharma Group, and Pantec. L Gennari received consultancy fees from Sandoz and Kyowa-Kirin., V Carnevale, A Scillitani, D Rendina, A Salcuni, V Toscano, V Triggiani, and S Cenci declare no competing interests.
Funding Information:
I Chiodini received consultancy fees from HRA Pharma and Corcept Therapeutics. A Gaudio received consultancy fees from Merck and UCB Pharma. A Palermo received consultancy fees from Amgen and Abiogen Pharma. N Napoli received consultancy fees from Eli Lilly, UCB Pharma and Abiogen Pharma. F Vescini received grants from Gilead Sciences LTD and Abiogen Pharma. A Falchetti received consultancy fees from Abiogen Pharma. DM received consultancy fees from Itapharma and UCB Pharma. C Eller-Vainicher received grants from Fondazione Eli-Lilly, and consultancy fees from Kyowa-Kirin and Amgen. G Pugliese received consultancy fees from Astra-Zeneca, Eli Lilly, Sigma-tau, and Takeda. F Bertoldo received grants from Abiogen Pharma, Amgen, and Eli Lilly and consultancies from Jansen and UCB Pharma. S Gonnelli received consultancy fees from Eli Lilly, Sandoz, Italfarmaco, and Abiogen Pharma. R Nuti received consultancy fees from Sandoz, Pharma Group, and Pantec. L Gennari received consultancy fees from Sandoz and Kyowa-Kirin., V Carnevale, A Scillitani, D Rendina, A Salcuni, V Toscano, V Triggiani, and S Cenci declare no competing interests.
Publisher Copyright:
© 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University
PY - 2021
Y1 - 2021
N2 - Aim: Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D. Data synthesis: The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively. Conclusions: Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting.
AB - Aim: Bone fragility is increasingly recognized as a relevant complication of type 2 diabetes (T2D) and diabetic patients with fragility fractures have higher mortality rates than non diabetic individuals or diabetic patients without fractures. However, current diagnostic approaches for fracture risk stratification, such as bone mineral density measurement or the use of risk assessment algorithms, largely underestimate fracture risk in T2D patients. A multidisciplinary expert panel was established in order to in order to formulate clinical consensus recommendations on bone health assessment and management of fracture risk in patients with T2D. Data synthesis: The following key questions were addressed: a) which are the risk factors for bone fragility in T2D?, b) which diagnostic procedures can be currently used to stratify fracture risk in T2D patients?, c) which are the effects of antidiabetic treatments on bone?, and d) how to prevent and treat bone fragility in T2D patients? Based on the available data members of this panel suggest that the stratification of fracture risk in patients with diabetes should firstly rely on the presence of a previous fragility fracture and on the individual risk profile, with the inclusion of T2D-specific risk factors (namely T2D duration above 10 yrs, presence of chronic T2D complications, use of insulin or thiazolidinediones and persistent HbA1c levels above 8% for at least 1 year). Two independent diagnostic approaches were then suggested in the presence or the absence of a prevalent fragility fracture, respectively. Conclusions: Clinical trials in T2D patients at risk for fragility fractures are needed to determine the efficacy and safety of available antiresorptive and anabolic agents in this specific setting.
KW - Antidiabetic drugs
KW - Bone fragility
KW - Fracture risk
KW - Osteoporosis
KW - Type 2 diabetes
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U2 - 10.1016/j.numecd.2021.04.014
DO - 10.1016/j.numecd.2021.04.014
M3 - Article
AN - SCOPUS:85107124612
VL - 31
SP - 2210
EP - 2233
JO - Nutrition, Metabolism and Cardiovascular Diseases
JF - Nutrition, Metabolism and Cardiovascular Diseases
SN - 0939-4753
IS - 8
ER -