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The International Osteoporosis Foundation (IOF) has called for patients with Type 1 diabetes to be regularly assessed for fracture risk.

A review by the IOF Bone and Diabetes Scientific Working Group notes that people with Type 1 diabetes have decreased bone mineral density and an up to six-fold increase in fracture risk. Yet health professionals who treat diabetic patients often do not recognise that fragility fractures are a major complication of the disease.

The review, published in the European Journal of Endocrinology, aims to provide endocrinologists with valuable information concerning fracture risk in T1DM (Type 1 diabetes mellitus) patients.

The authors say that the higher fracture risk in T1DM patients is not only due to decreased bone mineral density, but also to alterations in bone quality. Recent clinical studies point to impaired osteoblastic bone formation, with or without increased bone resorption. Insulin deficiency appears to be a major pathogenetic mechanism involved, along with glucose toxicity, marrow adiposity, inflammation, adipokine and other metabolic alterations that may play a role in altering bone turnover and bone quality.

Such findings underline the need for early evaluation and fracture prevention strategies, said Professor Serge Ferrari, chair of the IOF Bone and Diabetes Working Group and professor at Geneva University Hospital, Switzerland.

“As fragility fractures are a major complication of diabetes, fracture risk should be properly evaluated in patients with this disorder,” Prof. Ferrari added. “Research is urgently needed on the benefits and risks of osteoporosis therapy as so far none of the anti-osteoporotic agents have been tested for their anti-fracture efficacy in T1DM subjects. This is all the more reason for health professionals to focus on early evaluation and other fracture prevention strategies in their patients.”