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Ann Schwartz (San Francisco, USA)

Diabetes and bone

Topics to be covered

Studies suggest that patients with type 2 diabetes have an increased risk of fracture, particularly when their higher average bone density is taken into account. We will discuss the evidence for higher fracture risk in those with type 2 diabetes and the possible contributions of more frequent falls and reduced bone strength to increased risk. More frequent falls have been observed for diabetic patients in general and in particular for those using insulin. Although type 2 diabetes is associated with higher average BMD, higher levels of advanced glycation end products in bone collagen may weaken the bone. Differences in bone structure may also contribute to poor bone strength in diabetes. Use of thiazolidinediones (TZDs) has been reported to increase fracture risk and bone loss, particularly in women. We will discuss the effects of TZDs on the skeleton reported from clinical trials and observational studies.

Educational goals

After attending this Meet the Professor session, participants will be expected to:

• describe the evidence for an association between type 2 diabetes and fracture risk;
• understand the contribution of falls to fracture risk in type 2 diabetes;
• be familiar with possible mechanisms for decreased bone strength in type 2 diabetes;
• understand the evidence that TZDs are associated with increased fracture risk;
  

Target audience

Researchers, physicians and clinicians interested in the effects of type 2 diabetes and hypoglycemic medications on skeletal health.

Teaching methods

To involve the audience as much as possible, I will introduce each topic with some key points and then encourage questions from those attending. I will go into more depth on those topics that generate the most interest. Audience members will be encouraged to offer their own opinions, in addition to asking questions, in order to stimulate discussion.