Management of bone fragility in type 2 diabetes: Perspective from an interdisciplinary expert panel

Iacopo Chiodini, Agostino Gaudio, Andrea Palermo, Nicola Napoli, Fabio Vescini, Alberto Falchetti, Daniela Merlotti, Cristina Eller-Vainicher, Vincenzo Carnevale, Alfredo Scillitani, Giuseppe Pugliese, Domenico Rendina, Antonio Salcuni, Francesco Bertoldo, Stefano Gonnelli, Ranuccio Nuti, Vincenzo Toscano, Vincenzo Triggiani, Simone Cenci, Luigi Gennari

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2210-2233
JournalNutrition, Metabolism and Cardiovascular Diseases
Issue number8
Publication statusPublished - 2021


  • Antidiabetic drugs
  • Bone fragility
  • Fracture risk
  • Osteoporosis
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine


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