[Management of osteoporosis in diabetes mellitus].

Recent metaanalyses have revealed both type 1 and type 2 diabetes mellitus (DM) are associated with an increased risk of hip fracture. In type 1 DM, decreased bone mineral density (BMD) and diabetic vascular complications are associated with an increased risk of fracture. Hence, strict metabolic control with intensive insulin therapy combined with earlier BMD assessment is important to prevent osteoporotic fractures. In type 2 DM, fracture risk is increased despite increased BMD. Presence of diabetic vascular complications, advanced glycation of bone collagen, deranged bone turnover, and possibly certain types of anti-diabetic medications are related to an increased risk of fracture. Comprehensive management, including calcium and vitamin D rich diet, exercise together with tight metabolic control would be important to prevent fractures in type 2 DM. Special care may be necessary in the use of thiazolidinediones toward high fracture risk individuals, such as postmenopausal women.