Osteoporosis, Diabetes Treatments Assessed in New Review
In a recent systematic literature review, researchers developed recommendations for treating patients with both osteoporosis and type 2 diabetes.
The review sought to provide an optimal guide for treating patients with diabetes and osteoporosis by examining the effects of diabetes treatment on bone metabolism, and the effect of anti-osteoporotic medications on the incidence and control of type 2 diabetes.
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Recommendations included in the review were based on evidence from studies published until March 2017 located on PubMed, Cochrane, and EMBASE, and the evidence was graded using a grading system introduced by the American College of Physicians.
Among the recommendations:
- Metformin, sulfonylureas, DPP-4i, and GLP1-RA are the preferred treatment for type 2 diabetes patients with osteoporosis, but strict targets should not be implemented to avoid hypoglycemia, falls, and fractures.
- Insulin should be used with caution and with careful measures to avoid hypoglycemia.
- Insulin therapy is recommended for achieving glycemic control in patients hospitalized with type 2 diabetes and osteoporosis.
- Physicians should avoid prescribing TZDs and canagliflozin, while other SGLT2 inhibitors are less well-validated options.
“The treatment and monitoring of osteoporosis should be continued without important amendments because of the presence of [type 2 diabetes],” the researchers wrote.
Additionally, the authors concluded that a healthy diet and physical exercise were important for the prevention of both diabetes and osteoporosis.
—Melissa Weiss
Reference:
Paschou SA, Dede AD, Anagnostis PG, Vryonidou A, Morganstein D, Goulis DG. Type 2 diabetes and osteoporosis: a guide to optimal management [June 21, 2017]. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2017-00042.