[Diagnosis and management of patients with diabetes and co-existing osteoporosis (Update 2023) : Common guideline of the Austrian Society for Bone and Mineral Research and the Austrian Diabetes Society].

Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2023) : Gemeinsame Leitlinie der Österreichischen Gesellschaft für Knochen- und Mineralstoffwechsel und der Österreichischen Diabetes Gesellschaft.

Journal

Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R

Informations de publication

Date de publication:
Jan 2023
Historique:
accepted: 09 11 2022
medline: 28 4 2023
pubmed: 27 4 2023
entrez: 26 4 2023
Statut: ppublish

Résumé

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. The identification and management of fracture risk in these patients remains challenging. This manuscript explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated areal bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (FRAX) in these patients. It further reviews the impact of diabetes drugs on bone tissue as well as the efficacy of osteoporosis treatments in this population. An algorithm for the identification and management of diabetic patients at increased fracture risk is proposed. Diabetes mellitus und Osteoporose zählen zu den häufigsten chronischen Erkrankungen und kommen deshalb beide häufig in ein und demselben Individuum vor. Da die Prävalenz beider mit steigendem Alter zunimmt, wird in Anbetracht der Altersstruktur unserer Bevölkerung deren Häufigkeit zunehmen. innen mit Diabetes haben ein erhöhtes Risiko für Fragilitätsfrakturen. Die Pathophysiologie ist unklar und vermutlich multifaktoriell.Longitudinale Studien haben den Nachweis erbracht, dass das Fracture Risk Assessment Tool (FRAX) und die Knochendichte (BMD) mittels DXA (T-score) Messungen und einem eventuell vorhandenen Trabecular Bone Score (TBS) das individuelle Frakturrisiko vorhersagen können. Hierfür muss allerdings eine Adjustierung vorgenommen werden, um das Risiko nicht zu unterschätzen.Es gibt derzeit aus osteologischer Sicht noch nicht den optimalen Ansatz, da es keine Studien mit rein diabetischen Patient:innen und Osteoporose gibt. innen mit Diabetes mellitus und einem erhöhten Frakturrisiko sollten genauso wie Patient:innen ohne Diabetes und einem erhöhten Frakturrisiko behandelt werden.Der Vitamin-D-Spiegel sollte auf jeden Fall immer optimiert werden und auf eine ausreichende Kalziumaufnahme (vorzugsweise durch die Nahrung) ist zu achten.Bei der Wahl der antihyperglykämischen Therapie sollten Substanzen mit nachgewiesen negativem Effekt auf den Knochen weggelassen werden. Bei Vorliegen einer Fragilitätsfraktur ist auf jeden Fall – unabhängig von allen vorliegenden Befunden – eine langfristige spezifische osteologische Therapie indiziert.Zur Prävention von Fragilitätsfrakturen sind antiresorptive Medikamente die erste Wahl, entsprechend den nationalen Erstattungskriterien auch anabole Medikamente. Das Therapiemonitoring soll im Einklang mit der nationalen Osteoporose Leitlinie erfolgen.

Autres résumés

Type: Publisher (ger)
Diabetes mellitus und Osteoporose zählen zu den häufigsten chronischen Erkrankungen und kommen deshalb beide häufig in ein und demselben Individuum vor. Da die Prävalenz beider mit steigendem Alter zunimmt, wird in Anbetracht der Altersstruktur unserer Bevölkerung deren Häufigkeit zunehmen.

Identifiants

pubmed: 37101043
doi: 10.1007/s00508-022-02118-8
pii: 10.1007/s00508-022-02118-8
pmc: PMC10133052
doi:

Substances chimiques

Minerals 0

Types de publication

English Abstract Journal Article

Langues

ger

Sous-ensembles de citation

IM

Pagination

207-224

Informations de copyright

© 2023. The Author(s).

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Auteurs

Christian Muschitz (C)

II. Medizinische Abteilung, Barmherzige Schwestern Krankenhaus Wien, Wien, Österreich. christian.muschitz@meduniwien.ac.at.
Externe Lehre, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich. christian.muschitz@meduniwien.ac.at.

Alexandra Kautzky-Willer (A)

Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.

Yvonne Winhofer (Y)

Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.

Martina Rauner (M)

Bone Lab Dresden, Medizinische Klinik und Poliklinik III, Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland.

Judith Haschka (J)

Externe Lehre, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
I. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich.

Daniel Cejka (D)

III. Medizinische Abteilung mit Nieren- und Hochdruckerkrankungen, Transplantationsmedizin und Rheumatologie, Ordensklinikum Linz Elisabethinen, Linz, Österreich.

Robert Wakolbinger-Habel (R)

Externe Lehre, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
Institut für physikalische Medizin und Rehabilitation, Klinik Donaustadt, Wien, Österreich.

Peter Pietschmann (P)

Institut für Pathophysiologie & Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Wien, Österreich.

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