Managing Type 2 Diabetes, Osteoporosis Presents Challenges

Patients with type 2 diabetes (T2D) often have problems with bone health, including osteoporosis. Making medication decisions for patients with these chronic conditions can present problems for healthcare providers, as drugs for 1 condition may exacerbate another disease.

A new review published by the Journal of Clinical Endocrinology & Metabolism discusses effective treatment options for patients with T2D and osteoporosis.

Previous studies have explored the treatment of the conditions separately, but several discovered that patients with T2D have an increased risk of fracture.

It is thought that T2D affects bone metabolism and strength. Certain diabetes drugs affect bone metabolism, and diabetic complications may increase the risk of falls and fractures, according to the study.

"Metformin, sulfonylureas, DPP-4 inhibitors and GLP1 receptor agonists -- medications for T2D -- should be the preferred treatment for T2D in patients who also have osteoporosis," said first study author Stavroula A. Paschou, MD, PhD.

The authors note that these medications should be first-line treatments for patients with T2D because they can preserve bone health.

Previous studies show metformin has positive effects on bone formation and bone mineral density. The authors also note that DPP-4 inhibitors and GLP1 receptor antagonists have been observed to have a positive or neutral effect on bone metabolism.

The authors caution that thiazolidinediones and canagliflozin should not be taken by patients with T2D. SGLT2 inhibitors are less well-validated than other diabetes drugs, according to the study. Additionally, patients with diabetes should use insulin carefully to prevent hypoglycemia and related adverse events, according to the study.

The authors also reviewed past clinical trials and guidelines to craft recommendations for the optimal treatment of patients with T2D and osteoporosis. The team applied a grading system to each study based on the strength and quality of evidence for each treatment recommendation.

Based on the recommendations, the authors discovered that insulin is the preferred method for controlling blood glucose levels among hospitalized patients with T2D and fractures, according to the study.

The authors did not find any evidence of negative effects on glucose metabolism brought on by osteoporosis drugs; however, they found a potentially positive effect from treatment with bisphosphonates. Due to these findings, the investigators do not recommend changing treatment for osteoporosis for patients with T2D.

The authors advise that avoiding strict blood glucose targets are important for co-managing the conditions due to the fear of hypoglycemia, falls, and fractures, according to the study.

"A healthy diet and physical exercise are very important for the prevention and treatment of both conditions," Dr Paschou concluded.