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How may osteoporosis be prevented in individuals with diabetes?

Peter Vestergaard

Diabetes may be linked to osteoporosis in a number of ways. General prevention may include physical activity, which may improve both metabolic control and help prevent bone loss, and good metabolic control may prevent osteoporosis by counteracting the negative effects of hyperglycemia on bone. Of the drugs available for use against diabetes, the thiazolidinediones may lead to osteoporosis by altering the balance between osteoblastogenesis and adipocytogenesis, whereas other drugs such as insulin, sulfonylureas and metformin seem to prevent osteoporosis by improving metabolic control. The thiazolidinediones thus should not be used in patients at risk of osteoporosis. Among the antiresorptive treatments, bisphosphonates have been demonstrated to increase bone mineral density but no studies with fractures as end points are available. No studies of strontium or parathyroid hormone are available. More studies on the pathogenesis and treatment of osteoporosis in patients with diabetes are needed.